Discussion of  “ CBCT EVALUATION OF SKELETAL, DENTAL, AND VOLUMETRIC MAXILLARY SINUS CHANGES ASSOCIATED WITH TWO TYPES OF ...
 
CHECKLIST for DISCUSSER <ul><li>I.  THE RESEARCH PROBLEM </li></ul><ul><ul><li>1. Is there a statement of the problem and ...
CHECKLIST for DISCUSSER <ul><li>I.  THE RESEARCH PROBLEM </li></ul><ul><ul><li>1. Is there a statement of the problem and ...
CHECKLIST for DISCUSSER <ul><li>I.  THE RESEARCH PROBLEM </li></ul><ul><ul><li>1. Is there a statement of the problem and ...
CHECKLIST for DISCUSSER <ul><li>I.  THE RESEARCH PROBLEM </li></ul><ul><ul><li>1. Is there a statement of the problem and ...
II.  EXPERIMENTAL OR DESCRIPTIVE METHOD 1.  What is the population and how is it sampled? <ul><li>10 bonded </li></ul><ul>...
II.  EXPERIMENTAL OR DESCRIPTIVE METHOD 1.  What is the population and how is it sampled? CHECKLIST for DISCUSSER <ul><li>...
II.  EXPERIMENTAL OR DESCRIPTIVE METHOD 1.  What is the population and how is it sampled? 2. Research Design CHECKLIST for...
II.  EXPERIMENTAL OR DESCRIPTIVE METHOD 1.  What is the population and how is it sampled? 2. Research Design 3. Measuremen...
III.  Results of the Study   1.  Data analysis 2. Presentation of findings   CHECKLIST for DISCUSSER <ul><li>Straightforwa...
IV.  Discussion and Conclusion   1.  Discussion CHECKLIST for DISCUSSER <ul><li>“ Multiple studies 7,13,25  show that a de...
 
Suture opening not measured in this study  T2 at 6 months post active expansion
 
T here were significant midpalatal suture openings P  <0.05) <ul><li>First molar  4.33mm </li></ul><ul><li>Second deciduou...
 
Differences may be due to lack of suture opening?? Or not enough over expansion and subsequent uprighting with palatal arc...
 
IV.  Discussion and Conclusion   1.  Discussion CHECKLIST for DISCUSSER “ The decrease in opening of the posterior part of...
<ul><li>Discussion and Conclusion   1.  Discussion 2. Conclusion </li></ul>CHECKLIST for DISCUSSER <ul><li>No previous stu...
<ul><li>Discussion and Conclusion   1.  Discussion 2. Conclusion </li></ul>CHECKLIST for DISCUSSER <ul><li>I find it inter...
Thank you Valmy!
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Discussion of conebeam eval of expansion paper

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Discussion of conebeam eval of expansion paper

  1. 1. Discussion of “ CBCT EVALUATION OF SKELETAL, DENTAL, AND VOLUMETRIC MAXILLARY SINUS CHANGES ASSOCIATED WITH TWO TYPES OF MAXILLARY EXPANDERS” Ron Snyder, D.D.S. Apple Valley, Minnesota 80th Annual Midwest Angle Component Meeting Orlando, Florida
  2. 3. CHECKLIST for DISCUSSER <ul><li>I. THE RESEARCH PROBLEM </li></ul><ul><ul><li>1. Is there a statement of the problem and is it adequate? </li></ul></ul>“ The purpose of this study was to assess three dimensionally, with the aid of ICat technology, the maxillary skeletal, dental, soft tissue, and volumetric airway changes associated with the banded versus the bonded hyrax expanders.” I would have liked more background on the relevance of maxillary sinus volume in its relationship to airway dynamics
  3. 4. CHECKLIST for DISCUSSER <ul><li>I. THE RESEARCH PROBLEM </li></ul><ul><ul><li>1. Is there a statement of the problem and is it adequate? </li></ul></ul><ul><ul><li>2. Is the review of the literature adequate? </li></ul></ul>American Journal of Orthodontics and Dentofacial Orthopedics April 2010
  4. 5. CHECKLIST for DISCUSSER <ul><li>I. THE RESEARCH PROBLEM </li></ul><ul><ul><li>1. Is there a statement of the problem and is it adequate? </li></ul></ul><ul><ul><li>2. Is the review of the literature adequate? </li></ul></ul><ul><ul><li>3. Are important terms defined? </li></ul></ul><ul><li>Banded RPE </li></ul><ul><ul><li>4 banded RPE discussed – no buccal and lingual bars </li></ul></ul><ul><ul><li>“ mini Hyrax” shown </li></ul></ul><ul><li>Discussion of skeletal movement and dental tipping </li></ul><ul><ul><li>What about alveolar bending secondary to over expansion and subsequent adaptive bony morphologic changes? </li></ul></ul><ul><li>Diastema during expansion – term not used in the research design </li></ul><ul><li>What constitutes a “constricted” maxilla </li></ul>
  5. 6. CHECKLIST for DISCUSSER <ul><li>I. THE RESEARCH PROBLEM </li></ul><ul><ul><li>1. Is there a statement of the problem and is it adequate? </li></ul></ul><ul><ul><li>2. Is the review of the literature adequate? </li></ul></ul><ul><ul><li>3. Are important terms defined? </li></ul></ul><ul><ul><li>4. Are the hypotheses or objectives adequate? </li></ul></ul>No hypotheses in the presentation
  6. 7. II. EXPERIMENTAL OR DESCRIPTIVE METHOD 1. What is the population and how is it sampled? <ul><li>10 bonded </li></ul><ul><li>5 males 5 females </li></ul><ul><li>13.5 ± 2.1 years </li></ul><ul><li>13 banded </li></ul><ul><li>7 males 6 females </li></ul><ul><li>12.6 ± 1.8 years </li></ul>CHECKLIST for DISCUSSER Where did the patients come from?
  7. 8. II. EXPERIMENTAL OR DESCRIPTIVE METHOD 1. What is the population and how is it sampled? CHECKLIST for DISCUSSER <ul><li>Inclusion criteria – “absence of fluid accumulation in maxillary sinus” </li></ul><ul><ul><li>Deviated septum? </li></ul></ul><ul><ul><li>Nasal airway obstruction? </li></ul></ul><ul><ul><li>Characteristics of the population that needs maxillary expansion – maxilla morphology differs between a Class III patient and a Class II </li></ul></ul><ul><li>Inclusion criteria - “full permanent dentition” – 7s erupted? </li></ul>
  8. 9. II. EXPERIMENTAL OR DESCRIPTIVE METHOD 1. What is the population and how is it sampled? 2. Research Design CHECKLIST for DISCUSSER <ul><li>Research design was clearly formulated and described </li></ul><ul><li>There may be other experimental variables that might influence the results of the investigation </li></ul><ul><ul><li>Characteristics of the population – for example there is a response difference from a occlusally “trapped” maxilla and a genetically deficient maxilla </li></ul></ul><ul><ul><li>Quality of expansion – clinical response of midline diastema </li></ul></ul><ul><ul><li>Quantity of expansion - measure each screw opening or a directive to expand to just short of “buccal cross bite”– not standardized here </li></ul></ul>
  9. 10. II. EXPERIMENTAL OR DESCRIPTIVE METHOD 1. What is the population and how is it sampled? 2. Research Design 3. Measurement CHECKLIST for DISCUSSER <ul><li>All measures including the all important maxillary sinus volume measurement was consistent with what I found in the literature </li></ul><ul><li>Is maxillary sinus volume a measure of nasal airway resistance? </li></ul><ul><ul><li>Does maxillary sinus volume vary during respiration? </li></ul></ul><ul><li>Other reasonable measures of the factors under study </li></ul><ul><ul><li>Diastama response </li></ul></ul><ul><ul><li>Subjective nasal airway response </li></ul></ul>
  10. 11. III. Results of the Study 1. Data analysis 2. Presentation of findings CHECKLIST for DISCUSSER <ul><li>Straightforward and clear </li></ul><ul><ul><li>Were there between group differences due to the lack of randomization in assignment of the expansion type – bonded could have been assigned to the more vertical facial type who would have narrower maxillary arches (with more pre-expansion buccal tip of posterior teeth)? </li></ul></ul><ul><li>The summary statistical table’s purposes and contents were clear </li></ul>
  11. 12. IV. Discussion and Conclusion 1. Discussion CHECKLIST for DISCUSSER <ul><li>“ Multiple studies 7,13,25 show that a decrease in sutural opening can lead to dental tipping and alveolar bending” </li></ul><ul><ul><li>Variables that impact suture opening </li></ul></ul><ul><ul><ul><li>appliance design </li></ul></ul></ul><ul><ul><ul><li>number of turns per day </li></ul></ul></ul><ul><ul><ul><li>ease of diastema appearance </li></ul></ul></ul><ul><ul><ul><li>characteristics of the patient </li></ul></ul></ul>
  12. 14. Suture opening not measured in this study T2 at 6 months post active expansion
  13. 16. T here were significant midpalatal suture openings P <0.05) <ul><li>First molar 4.33mm </li></ul><ul><li>Second deciduous molar (second premolar if present) 4.36mm </li></ul><ul><li>First deciduous molar (first premolar if present) 4.46mm </li></ul><ul><li>Canine 4.33mm </li></ul>The midpalatal suture opening was parallel.
  14. 18. Differences may be due to lack of suture opening?? Or not enough over expansion and subsequent uprighting with palatal arch? Clinical suggestion…upright molars before expansion to maximize expansion and reduce side effects
  15. 20. IV. Discussion and Conclusion 1. Discussion CHECKLIST for DISCUSSER “ The decrease in opening of the posterior part of the maxillary suture was attributed to the interlocking of the pyramidal processes of the palatine bone along with immobilization of the medial and lateral pterygoid plates of the sphenoid bone.” ??????????
  16. 21. <ul><li>Discussion and Conclusion 1. Discussion 2. Conclusion </li></ul>CHECKLIST for DISCUSSER <ul><li>No previous studies have related anterior to posterior nasal bony changes. </li></ul><ul><li>Palatal expansion resulted in not only a posterior widening, but also an anterior widening of the nasal cavity. </li></ul><ul><li>The increase in maxillary sinus volume found in this investigation has not been previously reported. </li></ul>
  17. 22. <ul><li>Discussion and Conclusion 1. Discussion 2. Conclusion </li></ul>CHECKLIST for DISCUSSER <ul><li>I find it interesting that the anterior and posterior nasal widths increased equally (actually posterior more) in both samples in spite of the so called posterior resistance – this does not suggest a triangular opening – rather a parallel widening of the bony nose </li></ul>
  18. 23. Thank you Valmy!

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