This study aimed to assess the potential effects of two different osteotomy designs of the maxillary lateral wall on dental and skeletal changes after surgically assisted rapid maxillary expansion (SARME). Thirty adult patients were divided into two groups according to the lateral osteotomy design: group 1 (n=16) underwent lateral osteotomy performed in a horizontal straight fashion, and group 2 (n=14) underwent lateral osteotomy performed in parallel to the occlusal plane with a step at the zygomatic buttress. Cone beam computed tomography scans were obtained preoperatively (T1), immediately after expansion (T2), and 6 months after expansion (T3). Mixed analysis of variance (ANOVA) was used for the statistical analysis. The results showed no significant interaction effect between groups and time points. Therefore, maxillary expansion was effective in both groups. Statistically significant increases in all dental and skeletal measurements were observed immediately after expansion (P<0.001). Relapse of the nasal floor width, tipping of the supporting teeth, and an increase in root distance in molars occurred at T3 (P<0.05). In summary, the maxillary lateral osteotomy design did not influence the results of SARME, which occurred mainly through the inclination of maxillary segments.
The oblique radiograph at 45° was useful for the assessment of molar intrusion and anteroposterior displacement. The treatment of anterior open bite with skeletal anchorage provided intrusion of molars and counterclockwise rotation of the mandible, resulting in open bite closure.
The aim of this study was to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced with mandibular surgery first or maxillary surgery first. Thirty-two patients, divided into two groups, were included in this retrospective study. Group 1 comprised patients who received bimaxillary surgery following the classical sequence with repositioning of the maxilla first. Patients in group 2 received bimaxillary surgery, but the mandible was operated on first. The precision of the maxillomandibular repositioning was determined by comparison of the digital prediction and postoperative tracings superimposed on the cranial base. The data were tabulated and analyzed statistically. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy for A-point and the upper incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for aesthetics.
BackgroundThis study aimed to evaluate three-dimensional changes in mandibular position after surgically assisted rapid maxillary expansion (SARME).MethodsA retrospective study was carried out with tomographic records of 30 adult patients with maxillary transverse deficiency who underwent SARME. Cone beam computed tomography scans were obtained preoperatively (T1), after expansion (T2) and 6 months after expansion (T3). Mandibular landmarks were measured with respect to axial, sagittal, and coronal planes. Repeated measures ANOVA was used for statistical analysis.ResultsClockwise rotation and lateral displacement of the mandible were observed immediately after SARME. However, mandibular displacements tended to return close to their initial values at T3.ConclusionsClockwise rotation and lateral shift of the mandible are transient effects of SARME.
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