Midfacial changes in the coronal plane induced by microimplant-supported skeletal expander, studied with cone-beam computed tomography images

Cantarella, Daniele; Dominguez-Mompell, Ramon; Moschik, Christoph; Mallya, Sanjay M.; Pan, Hsin Chuan; Alkahtani, Mohammed; Elkenawy, Islam; Moon, Won

doi:10.1016/j.ajodo.2017.11.033

Cited by 86 publications

(75 citation statements)

References 29 publications

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“…This could be explained by the median and inferior location of the maxilla relative to the fulcrum. Due to the outward rotation of the zygomaticomaxillary complex around the frontozygomatic suture area, the maxillary halves moved downward and outward [37]. Concerning hard tissue changes, there were significant lateral movements of all evaluated hard tissue landmarks, a significant forward displacement of the A point, the prosthion, the ectocanine and a significant downward shift of the A point following MSE.…”

Section: Discussionmentioning

confidence: 93%

Three-dimensional evaluation of mid-facial soft tissue changes after expansion using micro-implant-supported maxillary skeletal expander

Nguyen

Shin

Giap

et al. 2020

Preprint

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Background The aim of this study was to assess the mid-facial soft tissue changes induced by a micro-implant-supported maxillary skeletal expander in late adolescents and young adults by cone-beam computerized tomography and the correlations between hard and soft tissue changes after expansion with maxillary skeletal expander.Subjects and methods Twenty patients with maxillary transverse deficiency treated with maxillary skeletal expander were selected. Cone-beam computerized tomography images taken before and after expansion were superimposed to measure the changes in soft and hard tissue landmarks.Results Anterior nasal spine, posterior nasal spine, and alveolar bone width were significantly increased after expansion with maxillary skeletal expander (p < 0.05). The average lateral movement of the cheek points was 1.13 ± 0.33 mm (left) and 1.41 ± 0.39 mm (right), while that of the alar curvature points was 1.07 ± 0.72 mm (left) and 1.06 ± 0.68 (right) (p < 0.05). The average forward displacement of the cheek points was 0.42 ± 0.66 mm (left) and 0.60 ± 0.58 mm (right), whereas that of the alar curvature points was 0.80 ± 0.67 mm (left) and 0.68 ± 0.56 mm (right) side (p < 0.05). The average downward movement of the subnasale was 0.40 ± 0.37 mm (p < 0.05). The changes in cheek points and alar curvature points on both sides significantly correlated with hard-tissue changes (p < 0.05).Conclusions Maxillary expansion using maxillary skeletal expander resulted in significant lateral and forward movement of soft tissues of the cheek and alar curvature points on both sides and correlated with the maxillary suture opening at the anterior and posterior nasal spines.

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Section: Discussionmentioning

confidence: 93%

Three-dimensional evaluation of mid-facial soft tissue changes after expansion using micro-implant-supported maxillary skeletal expander

Nguyen

Shin

Giap

et al. 2020

Preprint

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“…In the protocol developed, the center of MSE appliance and hence the expansion force vector is set by default in the same position as the CM point, defined by the projection of the bizygomatic line (BZL) on the posterior part of the midpalatal suture. In the literature, it has been described that the pterygopalatine suture 28,29 and the zygomatic buttress bone [23][24][25][26]30,31 are two major resistance structures that hamper the lateral maxillary movement. Furthermore, Lee et al 32 have shown that the center of resistance of the maxillary halves is located slightly superiorly and laterally to the root apex of maxillary second molars, close to the most lateral point of the zygomatic process of the maxilla (ZR and ZL) utilized in our protocol.…”

Section: Discussionmentioning

confidence: 99%

“…The application of the expansion force vector close to the maxillary center of resistance has the scope of maximizing the orthopedic effect on the midface during maxillary expansion. [23][24][25][26] If the CA is moved forward relative to the CM point, the midpalatal suture opening will be less parallel and more V-shaped, since the force vector will act in a more anterior part of the maxilla, away from its center of resistance. 32 Although MSE position relative to the bizygomatic line and CM point is the main objective of the digital planning due to biomechanical reasons, other parameters were taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

“…Bicortical skeletal anchorage is required for the correct functioning of MSE, since it increases the stability of microimplants. [20][21][22][23][24][25][26] Loss of skeletal anchorage stability and bending of micro-implants is a negative consequence of monocortical anchorage, 22 that seriously compromises the outcome of the therapy in adults and potentially also in growing patients.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, MARPE devices are used in association with the facemask to enhance the maxillary protraction, especially in patients older than 8-9 years of age. [17][18][19][20] The present paper aims to describe a novel procedure to position a particular type of MARPE appliance, the Maxillary Skeletal Expander (MSE), [20][21][22][23][24][25][26] in the patient's oral cavity through digital planning and workflow.…”

Section: Introductionmentioning

confidence: 99%

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<p>A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion</p>

Cantarella¹,

Savio²,

Grigolato³

et al. 2020

MDER

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Introduction: Miniscrew-assisted rapid palatal expansion (MARPE) appliances utilize the skeletal anchorage to expand the maxilla. One type of MARPE device is the Maxillary Skeletal Expander (MSE), which presents four micro-implants with bicortical engagement of the palatal vault and nasal floor. MSE positioning is traditionally planned using dental stone models and 2D headfilms. This approach presents some critical issues, such as the inability to identify the MSE position relative to skeletal structures, and the potential risk of damaging anatomical structures. Methods: A novel methodology has been developed to plan MSE position using the digital model of dental arches and cone-beam computed tomography (CBCT). A virtual model of MSE appliance with the four micro-implants was created. After virtual planning, a positioning guide is virtually designed, 3D printed, and utilized to model and weld the MSE supporting arms to the molar bands. The expansion device is then cemented in the patient oral cavity and micro-implants inserted. A clinical case of a 12.9-year-old female patient presenting a Class III malocclusion with transverse and sagittal maxillary deficiency is reported. Results: The midpalatal suture was opened with a split of 3.06 mm and 2.8 mm at the anterior and posterior nasal spine, respectively. After facemask therapy, the sagittal skeletal relationship was improved, as shown by the increase in ANB, A-Na perpendicular and Wits cephalometric parameters, and the mandibular plane rotated 1.6°clockwise. Conclusion: The proposed digital methodology represents an advancement in the planning of MSE positioning, compared to the traditional approach. By evaluating the bone morphology of the palate and midface on patient CBCT, the placement of MSE is improved regarding the biomechanics of maxillary expansion and the bone thickness at micro-implants insertion sites. In the present case report, the digital planning was associated with a positive outcome of maxillary expansion and protraction in safety conditions.

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Maxillary Expansion in Skeletally Mature Patients with TADs

Moon

2020

Temporary Anchorage Devices in Clinical Orthodontics

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Midfacial changes in the coronal plane induced by microimplant-supported skeletal expander, studied with cone-beam computed tomography images

Cited by 86 publications

References 29 publications

Three-dimensional evaluation of mid-facial soft tissue changes after expansion using micro-implant-supported maxillary skeletal expander

Three-dimensional evaluation of mid-facial soft tissue changes after expansion using micro-implant-supported maxillary skeletal expander

<p>A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion</p>

Maxillary Expansion in Skeletally Mature Patients with TADs

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