Objectives To evaluate the long-term effects on airway in patients with mini-screw–assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls with three-dimensional cone-beam computed tomography (CBCT) analysis. Materials and Methods A total of 180 CBCTs of 60 patients were analyzed at different time points, such as pretreatment, postexpansion, and posttreatment. Patients were divided into three groups: mini-screw assisted rapid palatal expansion (MARPE), rapid palatal expansion (RPE), and controls. The nasal cavity, nasopharyngeal, oropharyngeal, and laryngopharyngeal airway volume and area were measured. Changes in total airway volume, total airway area, minimal cross-sectional area, maxillary intermolar width, external maxillary width, and palatal width were also evaluated. Results Both MARPE and RPE caused a statistically significant increase in the airway after expansion as compared with the control group, but there was no statistically significant difference in the change in airway between MARPE, RPE, and the control group at posttreatment, except for nasopharyngeal volume, which was significantly increased in the MARPE group. There was no correlation between the amount of expansion and increase in total airway volume. Conclusions There was a significant increase in total airway volume, total airway area, and minimal cross-sectional area with MARPE and RPE immediately after expansion, but at posttreatment, the changes in the MARPE and RPE groups were similar to the change in the control group. However, MARPE led to a significant long-term increase in nasopharyngeal volume. The amount of expansion did not correlate with the increase in pharyngeal airway volume.

ObjectiveTo evaluate the accuracy and reliability of the diagnostic tools available for assessing maxillary transverse deficiencies.MethodsAn electronic search of three databases was performed from their date of establishment to April 2015, with manual searching of reference lists of relevant articles. Articles were considered for inclusion if they reported the accuracy or reliability of a diagnostic method or evaluation technique for maxillary transverse dimensions in mixed or permanent dentitions. Risk of bias was assessed in the included articles, using the Quality Assessment of Diagnostic Accuracy Studies tool-2.ResultsNine articles were selected. The studies were heterogeneous, with moderate to low methodological quality, and all had a high risk of bias. Four suggested that the use of arch width prediction indices with dental cast measurements is unreliable for use in diagnosis. Frontal cephalograms derived from cone-beam computed tomography (CBCT) images were reportedly more reliable for assessing intermaxillary transverse discrepancies than posteroanterior cephalograms. Two studies proposed new three-dimensional transverse analyses with CBCT images that were reportedly reliable, but have not been validated for clinical sensitivity or specificity. No studies reported sensitivity, specificity, positive or negative predictive values or likelihood ratios, or ROC curves of the methods for the diagnosis of transverse deficiencies.ConclusionsCurrent evidence does not enable solid conclusions to be drawn, owing to a lack of reliable high quality diagnostic studies evaluating maxillary transverse deficiencies. CBCT images are reportedly more reliable for diagnosis, but further validation is required to confirm CBCT's accuracy and diagnostic superiority.

Introduction: The aim of this multi-center retrospective study was to quantify the changes in alveolar bone height and thickness after using two different rapid palatal expansion (RPE) activation protocols, and to determine whether a more rapid rate of expansion is likely to cause more adverse effects, such as alveolar tipping, dental tipping, fenestration and dehiscence of anchorage teeth. Methods: The sample consisted of pre- and post-expansion records from 40 subjects (age 8-15 years) who underwent RPE using a 4-banded Hyrax appliance as part of their orthodontic treatment to correct posterior buccal crossbites. Subjects were divided into two groups according to their RPE activation rates (0.5 mm/day and 0.8 mm/day; n = 20 each group). Three-dimensional images for all included subjects were evaluated using Dolphin Imaging Software 11.7 Premium. Maxillary base width, buccal and palatal cortical bone thickness, alveolar bone height, and root angulation and length were measured. Significance of the changes in the measurements was evaluated using Wilcoxon signed-rank test and comparisons between groups were done using ANOVA. Significance was defined at p ≤ 0.05.Results: RPE activation rates of 0.5 mm per day (Group 1) and 0.8 mm per day (Group 2) caused significant increase in arch width following treatment; however, Group 2 showed greater increases compared to Group 1 (p < 0.01). Buccal alveolar height and width decreased significantly in both groups. Both treatment protocols resulted in significant increases in buccal-lingual angulation of teeth; however, Group 2 showed greater increases compared to Group 1 (p < 0.01).Conclusion: Both activation rates are associated with significant increase in intra-arch widths. However, 0.8 mm/day resulted in greater increases. The 0.8 mm/day activation rate also resulted in more increased dental tipping and decreased buccal alveolar bone thickness over 0.5 mm/day.

Obstructive sleep apnea (OSA) is a sleeping breathing disorder. In children, adenotonsillar hypertrophy remains the main anatomical risk factor of OSA. The aim of this study was to assess the current scientific data and to systematically summarize the evidence for the efficiency of adenotonsillectomy (AT) and orthodontic treatment (i.e., rapid maxillary expansion (RME) and mandibular advancement (MA)) in the treatment of pediatric OSA. A literature search was conducted in several databases, including PubMed, Embase, Medline, Cochrane and LILACS up to 5th April 2020. The initial search yielded 509 articles, with 10 articles being identified as eligible after screening. AT and orthodontic treatment were more effective together than separately to cure OSA in pediatric patients. There was a greater decrease in apnea hypoapnea index (AHI) and respiratory disturbance index (RDI), and a major increase in the lowest oxygen saturation and the oxygen desaturation index (ODI) after undergoing both treatments. Nevertheless, the reappearance of OSA could occur several years after reporting adequate treatment. In order to avoid recurrence, myofunctional therapy (MT) could be recommended as a follow-up. However, further studies with good clinical evidence are required to confirm this finding.

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 &lt; .05), and the nasal septal deviation angle significantly decreased (P &lt; .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 &lt; .05) in the MARPE and RPE groups as compared with controls, and the posterior nasal cavity width was significantly increased (P &lt; .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.

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Introduction: Patients presenting Temporomandibular Disorders (TMD) are common in our daily clinical practice. One of the possible conditions that lead to TMD is the habitual chewing side syndrome. Methods: In this case report a clinical approach is presented to manage the TMD related to unilateral vicious mastication. A 42 years old woman presented reporting headaches, difficulty to open mouth, presence of sensitivity in the left ear and TMJ region, soreness on the left side temporal region and sensitivity in the anterior inferior teeth. It was noted that the patient habitually clenched and ground teeth. Patient mentioned chew more on the left side. Results: After confirming the unilateral mastication, a modified therapy based on the Neuro occlusal Rehabilitation was applied through the use of a splint. After 60 days the patient described absence of the previous symptoms and pain relief. Conclusion: The evaluation of the masticatory pattern is often neglected; however, it is of great importance since it can lead to several conditions such as condyle wear, pain, alteration of the occlusal plane, deviation of the medial line, deviation of the mandible at mouth opening, bone alterations, Temporomandibular joint (TMJ) hypofunction, headache, among others.

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