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Rapid maxillary expansion procedure with Haas appliance; (A) Frontal oral photograph in pre-expansion phase; (B) Occlusal view with Hass appliance installed in the pre-expansion phase; (C) Occlusal view, immediate post-expansion; (D) Occlusal view, one year following expansion; (E) Frontal oral photograph in the post-expansion phase
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The aim of the present study was to use facial analysis to determine the effects of rapid maxillary expansion (RME) on nasal morphology in children in the stages of primary and mixed dentition, with posterior cross-bite.
Facial photographs (front view and profile) of 60 patients in the pre-expansion period, immediate post-expansion period and one y...
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Aim The aim of this study was to investigate the reaction of untouched permanent molars following RPE,
anchored on deciduous teeth in the early mixed dentition, aimed to solve maxillary anterior crowding in the
absence of posterior cross-bite.
Method A prospective clinical trial comprised 35 consecutive patients (20 males and 15 females) treated
by...
Citations
... Rapid maxillary expansion (RME) has been widely used to correct constricted maxillas. Recent studies have suggested that RME could improve nasal morphology and increase nasal cavity and maxillary sinus volume (MSV) (3)(4)(5)(6). In addition, it has been reported that maxillary transverse expansion might positively affect respiratory function and improve oxygen saturation (7). ...
Objective
To evaluate the effects of rapid maxillary expansion (RME) on mid-facial depth in early mixed dentition and to investigate the relationship between change in mid-facial depth and maxillary sinus and nasal cavity.MethodsA total of 35 patients with mixed dentition treated with a Haas expander were included in this retrospective study. All patients underwent a cone-beam computed tomography scan before and after rapid maxillary expansion. The Wilcoxon signed-rank test was performed to evaluate the changes in maxillary width, facial depth, maxillary sinus, and nasal cavity volume before and after expansion. Multiple linear regression analysis was applied to evaluate the correlations among them.ResultsThe hard and soft tissue facial depth in the middle third increased significantly (P < 0.001). The gain on the outer sagittal plane (1.04–1.52 mm) was slightly bigger than that on the inner sagittal plane (0.91–1.30 mm). Maxillary width and nasal cavity width increased 3.42 ± 0.93 mm (P < 0.001) and 2.25 ± 0.77 mm (P < 0.001), respectively, after treatment. A gain was also achieved in both nasal cavity volume (2,236.15 mm3, P < 0.001) and maxillary sinus volume (1,227.33 mm3, P < 0.001). Multiple linear regression analysis showed that with the increase in maxillary sinus volume, the facial depth increased as well (B = 0.455–0.683, P < 0.05). Also, statistically significant correlations were found between nasal width and nasal cavity volume (B = 0.384, P < 0.05).Conclusion
The depth of the middle third face increased significantly. The facial depth increase was related to the enlargement of maxillary sinus volume, while the nasal cavity volume gain was related to the nasal width increase. This indicated that RME might enhance the fullness of the mid-face and facilitate the patency of nose breathing.
... Previous studies have investigated the effect of maxillary expansion on facial parameters using photographic analysis, clinical examinations, and twodimensional (2D) posteroanterior cephalograms in the short term following expansion. 6,7 However, such methods have disadvantages such as frontal photographic error, examiner bias, patient movement during the clinical examination, as well as magnification, distortion, and difficulty in identifying structures accurately in traditional radiographs. ...
Objectives
To evaluate the long-term effects of mini-screw–assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls on the nasal cavity with cone-beam computed tomography (CBCT).
Materials and Methods
A total of 180 CBCT scans that were part of a previous randomized trial were evaluated retrospectively for 60 patients at pretreatment (T1), postexpansion (T2), and posttreatment (T3). Patients were randomly assigned into 3 groups: MARPE, RPE, and controls (time period T1 to T3; MARPE: 2 years 8 months; RPE: 2 years 9 months; control: 2 years 7 months). Nasal height, nasal length, nasion–ANS height, ANS–PNS length, pyriform height, and nasal septal deviation angle were measured. The changes in alar width, alar base width, anterior nasal cavity width, posterior nasal cavity width, maxillary intermolar width, and maxillary intercanine width were also evaluated.
Results
The alar base width, posterior nasal cavity width, anterior nasal cavity width, maxillary intercanine width, and maxillary intermolar width significantly increased (P < .05), and the nasal septal deviation angle significantly decreased (P < .05) in both the MARPE and RPE groups as compared with controls in the short term. In the long term, the nasal septal deviation angle was significantly decreased (P < .05) in the MARPE and RPE groups as compared with controls, and the posterior nasal cavity width was significantly increased (P < .05) in the MARPE group compared with the RPE group and controls.
Conclusions
MARPE and RPE led to a significant increase in the nasal cavity and alar base width compared with controls in the short term. In the long term, a significant increase was observed only in the posterior nasal cavity width with MARPE. Both MARPE and RPE led to a minimal decrease in nasal septal deviation angle in comparison with controls.
... However, it was reported that these changes were very small and highly variable [19]. On the other hand, Silva Filho et al. used 2D photographs and concluded that RME did not cause changes in nasal morphology [39]. These observations markedly differ from our findings, and the reason for this difference most likely lies in the different scanning methods. ...
Facial soft tissue esthetics is a priority in orthodontic treatment, and emerging of the digital technologies can offer new methods to help the orthodontist toward an esthetic outcome. This prospective study aimed to assess the soft tissue changes of the face after six months of retention following Rapid Maxillary Expansion (RME). The sample consisted of 25 patients (13 females, 12 males, mean age: 11.6 years) who presented with unilateral or bilateral posterior crossbite requiring RME, which was performed with a Hyrax expander. 3D facial images were obtained before treatment (T0) and at the end of a six-month retention period after the treatment (T1) using a structured-light 3D handheld scanner. Linear and angular measurements were performed and 3D deviation analyses were done for six morphological regions of the face. Significant changes in various areas of the nasal and the upper lip regions were observed. Based on the results of the study and within the limitations of the study, RME with a Hyrax expander results in significant morphological changes of the face after a six-month retention period.
... Previous studies have investigated the effect of maxillary expansion on facial parameters using photographic analysis, clinical examinations, and twodimensional (2D) posteroanterior cephalograms in the short term following expansion. 6,7 However, such methods have disadvantages such as frontal photographic error, examiner bias, patient movement during the clinical examination, as well as magnification, distortion, and difficulty in identifying structures accurately in traditional radiographs. ...
... They found an increase in nasal width post-orthopedic and surgical expansion that was maintained 1 year after treatment. Filho et al. 6 also used facial analysis to assess nasal morphology in children following RME and found contradictory results to Berger et al., 5 concluding that RME had no impact on nasal morphology. Johnson et al. 7 used a caliper and clinical measurements reporting significant increases of alar width (defined as greater alar cartilage) in the RME group in age groups 11 to 13 compared with a normative sample group, but this increase did not show a clinically significant effect. ...
... Johnson et al. 7 reported that alar base width increased 1.98 mm in the treated group compared with the control group, but the difference might not be clinically significant on the impact to the whole face. On the contrary, Filho et al. 6 showed no impact on nasal morphology using facial analysis, concluding that RME was incapable of influencing the nasal soft tissues. Torun reported no significant differences observed in soft tissue alar base, nostril width, nostril height, and nasolabial angle. ...
Objectives
To evaluate nasal soft and hard tissue changes immediately post–rapid maxillary expansion (RME) and to assess the stability of these changes using cone beam computed tomography (CBCT).
Materials and Methods
A total of 35 treatment group (TG) patients (18 girls, 17 boys; 9.39 ± 1.4) had a pre-RME CBCT and a post-RME CBCT approximately 66 days after expansion, and 25 patients had a follow-up CBCT 2.84 years later. A total of 28 control group (CG; no RME) patients (16 girls, 12 boys; 8.81 ± 1.6) had an initial CBCT and a CBCT an average of 2.25 years later. Soft and hard tissue nasal landmarks were measured in transverse, sagittal, and coronal planes of space on CBCT scans. Differences within the same group were evaluated by paired t-tests or Wilcoxon signed-rank tests. Long-term comparisons between TG and CG were evaluated by independent-sample t-tests or Wilcoxon rank-sum tests.
Results
Immediately post-RME, there were statistically significant mean increases of 1.6 mm of alar base width, 1.77 mm of pyriform height, and 3.57 mm of pyriform width (P < .05). CG showed the significant increases over 2.25 years (P < .001). Compared with CG, the long-term evaluation of TG demonstrated only pyriform height and pyriform width showed a statistically significant difference (P < .01).
Conclusions
Although RME produced some significant increase on the nasal soft tissue immediately after expansion, it regressed to the mean of normal growth and development over time. However, long-term evaluation of TG compared with CG showed only pyriform height and pyriform width to be affected by RME.
... Although the dental and skeletal effects of expansion using dental or skeletal anchorage are well documented, little information is available concerning the overlying soft tissue changes following these treatment modalities. The authors who have analyzed soft tissue changes associated with RME and SARME were more interested with nasomaxillary region (15)(16)(17)(18)(19)(20)(21)(22)(23). They reported modifications in cheek, upper lip and nasal morphology which were explained majorly by the transversal enlargement of the maxilla, except for few studies (19,23) reporting that RME did not have significant clinical effects on the nose. ...
... The authors who have analyzed soft tissue changes associated with RME and SARME were more interested with nasomaxillary region (15)(16)(17)(18)(19)(20)(21)(22)(23). They reported modifications in cheek, upper lip and nasal morphology which were explained majorly by the transversal enlargement of the maxilla, except for few studies (19,23) reporting that RME did not have significant clinical effects on the nose. Furthermore, it has been pointed out that the immediate maxillary advancement with downward and backward mandibular rotation during maxillary expansion could have an effect on the patients' soft tissue profiles (24)(25)(26)(27)(28)(29)(30). ...
... Also, employing a similar surgical technique with present study, Magnusson et al. (21) found minor but statistically significant changes demonstrating anterior movement of the nose following tooth-borne SARME, with no evident modification of subnasale. In the present study, there was no effect of RME on nose prominence, similar to the results reported by Kılıç et al. (33) and da Silva Filho et al. (23) suggesting that RME does not alter nasal morphology which also held true for the SARME group. The patients in the current study were not specified according to a certain growth pattern and no initial sagittal and vertical differentiations were made similar to other studies in this field. ...
Purpose: The aims of this retrospective study were to evaluate the possible changes in soft tissue facial profile induced by orthopedic rapid maxillary expansion (RME) and surgically assisted rapid maxillary expansion (SARME), and to correlate them with the underlying hard tissue alterations.
Materials and Methods: 16 patients who received bone borne SARME and 25 patients who were subjected to RME using metal cast splint hyrax appliance were analyzed retrospectively. This research was conducted on lateral cephalometric radiographs taken on 2 occasions: before expansion (T1) and at the beginning of any further orthodontic treatment (T2). Investigated lateral cephalometric parameters consisted of Holdaway soft tissue measurements with some supplementary soft tissue, skeletal and dental assessments.
Results: The acquisition of T2 cephalograms which conforms to the initiation of further orthodontic treatment corresponded to 83.25±3.51 days for SARME and 85.68±4.37 days for RME after the expansion was completed. The only significant change in soft tissue profile of the SARME group was a decrease in upper lip thickness (p
A major objective of orthognatic surgery is the aesthetic outcome. Treatments only correcting for dentoskeletal deformities are not sufficient for optimal facial results because undesirable soft tissue changes may accompany skeletal manipulations. The primary objective of this study was to investigate alar base width (ABW) changes a minimum of 6 months following surgically-assisted rapid palatal expansion (SARPE). The following electronic databases and citation indices were searched: PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Virtual Health Library. The search included articles published until September 2015 without language restriction. The intervention was SARPE with maxillary vestibular incision from first molar to contralateral first molar, a modified LeFort I osteotomy with or without pterygomaxillary disjunction, and a V-Y closure. The primary outcome was the unstandardized mean difference between pre and postoperative ABW. A random effects meta-analysis was performed to combine study results, and included studies that were assessed for statistical heterogeneity using a Chi-square test for independence. The results of this meta-analysis (N = 41) showed a significant + 1.74 mm, 95% CI [0.14, 3.34] ABW increase in patients submitted to SARPE. There was no statistical heterogeneity among included studies (χ² = 0.03; df = 2; P = 0.98). ABW increases were observed despite including cinched patients in the analysis. None of the three included studies were completely free of bias. The most prominent flaws were measurement bias, limited sample size, and patient recruitment.
Objective
Changes in soft tissue in various morphological regions of the face immediately after rapid maxillary expansion (RME) were examined using three-dimensional (3D) deviation analyses.
Patients and methods
A total of 50 patients were included in the study; 25 patients (11 female and 14 male) presented with a unilateral or bilateral posterior crossbite malocclusion requiring RME. In addition, 25 patients (13 female and 12 male) were included as a control group. The mean ages of the study group and control group were 9.8 years (range 8.1–12.6 years) and 9.6 years (range 8.3–12.2 years), respectively. The 3D stereophotogrammetric images acquired immediately before the appliance was cemented and after expansion had been completed in the treatment group were compared using Rapidform software. The 3D deviation analyses were made for the complete face and in the upper and lower face, upper and lower lips and nose regions. The amount of negative and positive deviations and the mean deviations were examined on the facial meshes for the 95th percentiles.
Results
Immediately after RME, the mean absolute deviation over the complete face was 0.54 ± 0.16 mm. The mean change for the upper face was 0.42 ± 0.17 mm (mean positive deviation: 0.37 ± 0.17 mm; mean negative deviation: −0.48 ± 0.18 mm). The mean absolute deviation was 0.62 ± 0.28 mm in the upper lip and 0.60 ± 0.34 mm in the lower lip. In the nose area, the absolute deviation was 0.41 ± 0.21 mm (mean positive deviation: 0.39 ± 0.16 mm; mean negative deviation: −0.43 ± 0.26 mm).
Conclusions
Changes in facial soft tissues in the upper face, lower face, nasal soft tissues, and lower and upper lip regions were observed after RME.
Background:
Rapid maxillary expansion (RME) is used to expand the narrow maxilla. Dental and skeletal affects have previously been reported but few studies have reported on the overlying soft tissue changes. This study reports on the immediate effects of RME on the naso-maxillary facial soft tissue using 3D stereophotogrammetry.
Methods:
Fourteen patients requiring upper arch expansion using RME as part of their full comprehensive orthodontic plan were recruited. Cone beam CT scans and stereophotogrammetry images were taken for each patient; pre-RME activation (T0) and immediately post-RME expansion (T1). Based on twenty-three landmarks, 13 linear and 3 angular measurements were made from each of the stereophotogrammetry images. A linear measurement at ANS was taken from each CBCT image. Using a Wilcoxon signed rank test, the pre-RME and post-RME measurements were compared.
Results:
The mean separation of the anterior nasal spine was 3.8 mm ± 1.2 mm. The largest median increase was in nasal base width (1.6 mm), which was statistically significant (p = 0.001). Changes in the nasal dorsum height, nasal tip protrusion, philtrum width, and upper lip length were not statistically significant (p < 0.05). No significant differences were observed in the nostril linear measurements, expect for columella width (p = 0.009). Naso-labial angle decreased but was not statistically significant (p = 0.276). The only statically significant angular change was an increase in the nasal tip displacement angle (p = 0.001).
Conclusion:
Rapid maxillary expansion produces subtle changes in the naso-maxillary soft tissue complex. There is an increase in nasal base width, retraction and flattening of the nasal tip. These changes are small, less than 2 mm and variable between patients.
