The purpose of this study was to examine the maxillary response on the transverse dimensions to rapid palatal expansion (RPE) by using cone-beam computed tomography (CBCT).
Effects of rapid palatal expansion on the sagittal and vertical dimensions of...EdwardHAngle
The purpose of this study was to use cone-beam computed tomography imaging to examine the skeletal and dental changes in the sagittal and vertical dimensions after rapid palatal expansion.
Role of polycystin 1 in bone remodeling- orthodontic tooth movement study in ...EdwardHAngle
Objective: To test the hypothesis that polycystin-1 (PC1) is involved in orthodontic tooth movement as a mechanical sensor.
Materials and Methods: The response to force application was compared between three mutant and four wild-type 7-week-old mice. The mutant mice were PC1/Wnt1-cre, lacking PC1 in the craniofacial region. An orthodontic closed coil spring was bonded between the incisor and the left first molar, applying 20 g of force for 4 days. Micro–computed tomography, hematoxylin and eosin staining, and tartrate-resistent acid phosphatase (TRAP) staining were used to study the differences in tooth movement among the groups.
Results: In the wild-type mice the bonded molar moved mesially, and the periodontal ligament (PDL) was compressed in the compression side. The compression side showed a hyalinized zone, and osteoclasts were identified there using TRAP staining. In the mutant mice, the molar did not move, the incisor tipped palatally, and there was slight widening of the PDL in the tension area. Osteoclasts were not seen on the bone surface or on the compression side. Osteoclasts were only observed on the other side of the bone—in the bone marrow.
Conclusions: These results suggest a difference in tooth movement and osteoclast activity between PC1 mutant mice and wild-type mice in response to orthodontic force. The impaired tooth movement and the lack of osteoclasts on the bone surface in the mutant working side may be related to lack of signal from the PDL due to PC1 deficiency.
Influence of common fixed retainers on the diagnostic quality of cranial magn...EdwardHAngle
Introduction: Orthodontists are often asked to remove fixed retainers before magnetic resonance imaging
(MRI). This study was undertaken to assess the effects of 2 commonly used fixed retainers on MRI distortion
and whether they should be removed. Methods: MRI scans were performed on a dry skull with Twistflex (Dentaurum,
Ispringen, Germany) and Ortho Flex Tech (Reliance Orthodontic Products, Itasca, Ill) retainers. Two
neuroradiologists independently ranked the distortions. The influence of the fixed retainers' alloys, their distance
to the area of diagnosis, location, strength of the magnetic field, and the spin-echo sequence were examined.
Statistical analysis included kappa and Pearson chi-square tests. Results: Ortho Flex Tech retainers caused
no distortion. Twistflex retainers caused distortion in 46% of the tests in areas close to the retainer (tongue
and jaws). Maxillary fixed retainers and the combination of maxillary and mandibular fixed retainers further
increased the distortion. Greater distortion was observed with 3-T magnetic fields and T1-weighted spin-echo
sequences. Conclusions: Removal of the Ortho Flex Tech retainer is unnecessary before MRI. Removal of
the Twistflex should be considered if the MRI scans are performed to diagnose areas close to the fixed retainers,
when 3-T magnetic fields and T1-weighted sequences are used, and when both maxillary and mandibular fixed
retainers are present.
Craniofacial growth in untreated skeletal class i subjects with low, average,...EdwardHAngle
The dental measurements showed few changes with growth in all groups. In terms of skeletal measurements from ages 9 to 18, similar growth changes were found between the sexes in most angular measurements, but males had larger values in linear measurements than females.
Purpose: To assess the amount of dental and skeletal expansion and stability after surgically assisted
rapid maxillary expansion (SARPE).
Patients and Methods: Data from 20 patients enrolled in this prospective study were collected before
treatment, at maximum expansion, at the removal of the expander 6 months later, before any second
surgical phase, and at the end of orthodontic treatment, using posteroanterior cephalograms and dental
casts.
Results: With SARPE, the mean maximum expansion at the first molar was 7.48 1.39 mm, and the
mean relapse during postsurgical orthodontics was 2.22 1.39 mm (30%). At maximum, a 3.49 1.37
mm skeletal expansion was obtained, and this expansion was stable, such that the average net expansion
was 67% skeletal.
Conclusion: Clinicians should anticipate a loss of about one third of the transverse dental expansion
obtained with SARPE, although the skeletal expansion is quite stable. The amount of postsurgical relapse
with SARPE appears quite similar to the changes in dental-arch dimensions after nonsurgical rapid palatal
expansion, and also quite similar to dental-arch changes after segmental maxillary osteotomy for
expansion.
Effects of rapid palatal expansion on the sagittal and vertical dimensions of...EdwardHAngle
The purpose of this study was to use cone-beam computed tomography imaging to examine the skeletal and dental changes in the sagittal and vertical dimensions after rapid palatal expansion.
Role of polycystin 1 in bone remodeling- orthodontic tooth movement study in ...EdwardHAngle
Objective: To test the hypothesis that polycystin-1 (PC1) is involved in orthodontic tooth movement as a mechanical sensor.
Materials and Methods: The response to force application was compared between three mutant and four wild-type 7-week-old mice. The mutant mice were PC1/Wnt1-cre, lacking PC1 in the craniofacial region. An orthodontic closed coil spring was bonded between the incisor and the left first molar, applying 20 g of force for 4 days. Micro–computed tomography, hematoxylin and eosin staining, and tartrate-resistent acid phosphatase (TRAP) staining were used to study the differences in tooth movement among the groups.
Results: In the wild-type mice the bonded molar moved mesially, and the periodontal ligament (PDL) was compressed in the compression side. The compression side showed a hyalinized zone, and osteoclasts were identified there using TRAP staining. In the mutant mice, the molar did not move, the incisor tipped palatally, and there was slight widening of the PDL in the tension area. Osteoclasts were not seen on the bone surface or on the compression side. Osteoclasts were only observed on the other side of the bone—in the bone marrow.
Conclusions: These results suggest a difference in tooth movement and osteoclast activity between PC1 mutant mice and wild-type mice in response to orthodontic force. The impaired tooth movement and the lack of osteoclasts on the bone surface in the mutant working side may be related to lack of signal from the PDL due to PC1 deficiency.
Influence of common fixed retainers on the diagnostic quality of cranial magn...EdwardHAngle
Introduction: Orthodontists are often asked to remove fixed retainers before magnetic resonance imaging
(MRI). This study was undertaken to assess the effects of 2 commonly used fixed retainers on MRI distortion
and whether they should be removed. Methods: MRI scans were performed on a dry skull with Twistflex (Dentaurum,
Ispringen, Germany) and Ortho Flex Tech (Reliance Orthodontic Products, Itasca, Ill) retainers. Two
neuroradiologists independently ranked the distortions. The influence of the fixed retainers' alloys, their distance
to the area of diagnosis, location, strength of the magnetic field, and the spin-echo sequence were examined.
Statistical analysis included kappa and Pearson chi-square tests. Results: Ortho Flex Tech retainers caused
no distortion. Twistflex retainers caused distortion in 46% of the tests in areas close to the retainer (tongue
and jaws). Maxillary fixed retainers and the combination of maxillary and mandibular fixed retainers further
increased the distortion. Greater distortion was observed with 3-T magnetic fields and T1-weighted spin-echo
sequences. Conclusions: Removal of the Ortho Flex Tech retainer is unnecessary before MRI. Removal of
the Twistflex should be considered if the MRI scans are performed to diagnose areas close to the fixed retainers,
when 3-T magnetic fields and T1-weighted sequences are used, and when both maxillary and mandibular fixed
retainers are present.
Craniofacial growth in untreated skeletal class i subjects with low, average,...EdwardHAngle
The dental measurements showed few changes with growth in all groups. In terms of skeletal measurements from ages 9 to 18, similar growth changes were found between the sexes in most angular measurements, but males had larger values in linear measurements than females.
Purpose: To assess the amount of dental and skeletal expansion and stability after surgically assisted
rapid maxillary expansion (SARPE).
Patients and Methods: Data from 20 patients enrolled in this prospective study were collected before
treatment, at maximum expansion, at the removal of the expander 6 months later, before any second
surgical phase, and at the end of orthodontic treatment, using posteroanterior cephalograms and dental
casts.
Results: With SARPE, the mean maximum expansion at the first molar was 7.48 1.39 mm, and the
mean relapse during postsurgical orthodontics was 2.22 1.39 mm (30%). At maximum, a 3.49 1.37
mm skeletal expansion was obtained, and this expansion was stable, such that the average net expansion
was 67% skeletal.
Conclusion: Clinicians should anticipate a loss of about one third of the transverse dental expansion
obtained with SARPE, although the skeletal expansion is quite stable. The amount of postsurgical relapse
with SARPE appears quite similar to the changes in dental-arch dimensions after nonsurgical rapid palatal
expansion, and also quite similar to dental-arch changes after segmental maxillary osteotomy for
expansion.
Malposition of unerupted mandibular second premolar in children with palatall...EdwardHAngle
Objective: To test the hypotheses that (1) the distal angulation of unerupted mandibular premolar
(MnP2) is significantly greater in children with palatally displaced canines (PDC) than in those in
a control sample; and (2) delayed tooth formation is significantly more frequent in children with
both malposed MnP2 and PDC than in children with PDC only.
Materials and Methods: We examined retrospectively panoramic radiographs from 43 patients
with PDC who had no previous orthodontics. A control sample consisted of age- and sex-matched
patients. The distal angle formed between the long axis of MnP2 and the tangent to the inferior
border was measured. Dental age was evaluated using the Koch classification.
Results: A significant difference was observed between the mean inclination of the right side
MnP2 in the PDC group (75.4 degrees) and that of the control group (85.8 degrees). This difference
was highly statistically significant (P < .0001). The same evaluation was carried out for the
left side, with similar results. The average dental age was found to be delayed in patients who
showed both abnormalities (malposed MnP2 and PDC) compared with patients who showed the
PDC anomaly only.
Conclusion: Both hypotheses are retained. Statistically, PDC and MnP2 malposition are significantly
associated suggesting a common genetic etiology, despite taking place on opposite jaws.
While the presence of PDC or MnP2 anomaly has been associated with a delay in tooth formation,
we find the presence of both anomalies to show a more profound delay. Our findings suggest a
delay in tooth formation as a possible common genetic mechanism for these 2 malposition anomalies.
Transverse growth of the maxilla and mandible in untreated girls with low, av...EdwardHAngle
The purpose of this study was to investigate maxillary and mandibular transverse growth in
untreated female subjects with low, average, and high mandibular plane angles longitudinally from ages 6 to 18.
Subjective classification and objective analysis of the mandibular dental arc...EdwardHAngle
Our objective was to evaluate the relationship between subjective classification of dental-arch shape, objective analyses via arch-width measurements, and the fitting with the fourth-order polynomial equation.
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Malposition of unerupted mandibular second premolar in children with cleft li...EdwardHAngle
Objective: To determine whether distoangular malposition of the unerupted mandibular second
premolar (MnP2) is more frequent in children with unilateral clefts of the lip and palate.
Materials and Methods: This retrospective study examined panoramic radiographs from 45 patients
with unilateral clefts of the lip and/or palate who had no previous orthodontics. A control
sample consisted of age- and sex-matched patients. The distal angle formed between the long
axis of MnP2 and the tangent to the inferior border was measured. The mean, standard deviation,
and range were calculated for the angles measured in the cleft and the control groups. The
significance of the differences between the means was evaluated by the paired t-test. The angles
of the cleft and noncleft sides were also measured and compared.
Results: The mean inclination of the MnP2 on the cleft side was 73.6°, compared with 84.6° in
the control group. This difference was highly significant statistically (P < .0001). The difference
in angles from the cleft and noncleft sides was 0.7°, not statistically significant. A significant association
was found between clefting and distoangular malposition of the developing MnP2, suggesting
a shared genetic etiology. This association is independent of the clefting side, ruling out
possible local mechanical effects.
Conclusion: Clinicians should be aware of the potential for anomalous development of MnP2 in
children with clefts.
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
Gingival recession—can orthodontics be a cure? evidence from a case presentationEdwardHAngle
Does orthodontic treatment help or hinder a patient’s periodontal status? What factors affect the
periodontium? Can those factors be managed in a way that remedies existing periodontal issues?
A 35-year-old woman presented with severe gingival recession and a unilateral Class II
malocclusion. The treatment plan was to correct the malocclusion in a way that torques the roots
more onto bone and to change her dental hygiene methods. With an extensive review of the
literature, this case review attempts to make sense of the enigma of gingival recession and
demonstrates an excellent treatment solution to concomitant orthodontic and periodontal
problems.
Angular changes and their rates in concurrence to developmental stages of the...EdwardHAngle
In the early developmental stage of the mandibular second premolar (MnP2), it is not unusual to find the tooth extremely angulated to the lower border of the mandible, as seen in the panoramic roentgenogram. On eruption, the tooth, in most cases, is close to being upright. However, impaction or other types of malocclusions due to its ectopic eruption are not rare.
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Mandibular arch form the relationship between dental and basal anatomyEdwardHAngle
We investigated mandibular dental arch form at the levels of both the clinically relevant application points of the orthodontic bracket and the underlying anatomic structure of the apical base. The correlation of both forms was evaluated and examined to determine whether the basal arch could be used to derive a standardized clinical arch form.
Increased occurrence of dental anomalies associated with infraocclusion of de...EdwardHAngle
Objective: To test the null hypothesis that there is no relationship between infraocclusion and the
occurrence of other dental anomalies in subjects selected for clear-cut infraocclusion of one or
more deciduous molars.
Materials and Methods: The experimental sample consisted of 99 orthodontic patients (43 from
Boston, Mass, United States; 56 from Jerusalem, Israel) with at least one deciduous molar in
infraocclusion greater than 1 mm vertical discrepancy, measured from the mesial marginal ridge of
the first permanent molar. Panoramic radiographs and dental casts were used to determine the
presence of other dental anomalies, including agenesis of permanent teeth, microdontia of
maxillary lateral incisors, palatally displaced canines (PDC), and distal angulation of the mandibular
second premolars (MnP2-DA). Comparative prevalence reference values were utilized and
statistical testing was performed using the chi-square test (P< .05) and odds ratio.
Results: The studied dental anomalies showed two to seven times greater prevalence in the
infraocclusion samples, compared with reported prevalence in reference samples. In most cases,
the infraoccluded deciduous molar exfoliated eventually and the underlying premolar erupted
spontaneously. In some severe phenotypes (10%), the infraoccluded deciduous molar was
extracted and space was regained to allow uncomplicated eruption of the associated premolar.
Conclusion: Statistically significant associations were observed between the presence of
infraocclusion and the occurrence of tooth agenesis, microdontia of maxillary lateral incisors,
PDC, and MnP2-DA. These associations support a hypothesis favoring shared causal genetic
factors. Clinically, infraocclusion may be considered an early marker for the development of later
appearing dental anomalies, such as tooth agenesis and PDC.
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Malposition of unerupted mandibular second premolar in children with palatall...EdwardHAngle
Objective: To test the hypotheses that (1) the distal angulation of unerupted mandibular premolar
(MnP2) is significantly greater in children with palatally displaced canines (PDC) than in those in
a control sample; and (2) delayed tooth formation is significantly more frequent in children with
both malposed MnP2 and PDC than in children with PDC only.
Materials and Methods: We examined retrospectively panoramic radiographs from 43 patients
with PDC who had no previous orthodontics. A control sample consisted of age- and sex-matched
patients. The distal angle formed between the long axis of MnP2 and the tangent to the inferior
border was measured. Dental age was evaluated using the Koch classification.
Results: A significant difference was observed between the mean inclination of the right side
MnP2 in the PDC group (75.4 degrees) and that of the control group (85.8 degrees). This difference
was highly statistically significant (P < .0001). The same evaluation was carried out for the
left side, with similar results. The average dental age was found to be delayed in patients who
showed both abnormalities (malposed MnP2 and PDC) compared with patients who showed the
PDC anomaly only.
Conclusion: Both hypotheses are retained. Statistically, PDC and MnP2 malposition are significantly
associated suggesting a common genetic etiology, despite taking place on opposite jaws.
While the presence of PDC or MnP2 anomaly has been associated with a delay in tooth formation,
we find the presence of both anomalies to show a more profound delay. Our findings suggest a
delay in tooth formation as a possible common genetic mechanism for these 2 malposition anomalies.
Transverse growth of the maxilla and mandible in untreated girls with low, av...EdwardHAngle
The purpose of this study was to investigate maxillary and mandibular transverse growth in
untreated female subjects with low, average, and high mandibular plane angles longitudinally from ages 6 to 18.
Subjective classification and objective analysis of the mandibular dental arc...EdwardHAngle
Our objective was to evaluate the relationship between subjective classification of dental-arch shape, objective analyses via arch-width measurements, and the fitting with the fourth-order polynomial equation.
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Malposition of unerupted mandibular second premolar in children with cleft li...EdwardHAngle
Objective: To determine whether distoangular malposition of the unerupted mandibular second
premolar (MnP2) is more frequent in children with unilateral clefts of the lip and palate.
Materials and Methods: This retrospective study examined panoramic radiographs from 45 patients
with unilateral clefts of the lip and/or palate who had no previous orthodontics. A control
sample consisted of age- and sex-matched patients. The distal angle formed between the long
axis of MnP2 and the tangent to the inferior border was measured. The mean, standard deviation,
and range were calculated for the angles measured in the cleft and the control groups. The
significance of the differences between the means was evaluated by the paired t-test. The angles
of the cleft and noncleft sides were also measured and compared.
Results: The mean inclination of the MnP2 on the cleft side was 73.6°, compared with 84.6° in
the control group. This difference was highly significant statistically (P < .0001). The difference
in angles from the cleft and noncleft sides was 0.7°, not statistically significant. A significant association
was found between clefting and distoangular malposition of the developing MnP2, suggesting
a shared genetic etiology. This association is independent of the clefting side, ruling out
possible local mechanical effects.
Conclusion: Clinicians should be aware of the potential for anomalous development of MnP2 in
children with clefts.
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
Gingival recession—can orthodontics be a cure? evidence from a case presentationEdwardHAngle
Does orthodontic treatment help or hinder a patient’s periodontal status? What factors affect the
periodontium? Can those factors be managed in a way that remedies existing periodontal issues?
A 35-year-old woman presented with severe gingival recession and a unilateral Class II
malocclusion. The treatment plan was to correct the malocclusion in a way that torques the roots
more onto bone and to change her dental hygiene methods. With an extensive review of the
literature, this case review attempts to make sense of the enigma of gingival recession and
demonstrates an excellent treatment solution to concomitant orthodontic and periodontal
problems.
Angular changes and their rates in concurrence to developmental stages of the...EdwardHAngle
In the early developmental stage of the mandibular second premolar (MnP2), it is not unusual to find the tooth extremely angulated to the lower border of the mandible, as seen in the panoramic roentgenogram. On eruption, the tooth, in most cases, is close to being upright. However, impaction or other types of malocclusions due to its ectopic eruption are not rare.
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Mandibular arch form the relationship between dental and basal anatomyEdwardHAngle
We investigated mandibular dental arch form at the levels of both the clinically relevant application points of the orthodontic bracket and the underlying anatomic structure of the apical base. The correlation of both forms was evaluated and examined to determine whether the basal arch could be used to derive a standardized clinical arch form.
Increased occurrence of dental anomalies associated with infraocclusion of de...EdwardHAngle
Objective: To test the null hypothesis that there is no relationship between infraocclusion and the
occurrence of other dental anomalies in subjects selected for clear-cut infraocclusion of one or
more deciduous molars.
Materials and Methods: The experimental sample consisted of 99 orthodontic patients (43 from
Boston, Mass, United States; 56 from Jerusalem, Israel) with at least one deciduous molar in
infraocclusion greater than 1 mm vertical discrepancy, measured from the mesial marginal ridge of
the first permanent molar. Panoramic radiographs and dental casts were used to determine the
presence of other dental anomalies, including agenesis of permanent teeth, microdontia of
maxillary lateral incisors, palatally displaced canines (PDC), and distal angulation of the mandibular
second premolars (MnP2-DA). Comparative prevalence reference values were utilized and
statistical testing was performed using the chi-square test (P< .05) and odds ratio.
Results: The studied dental anomalies showed two to seven times greater prevalence in the
infraocclusion samples, compared with reported prevalence in reference samples. In most cases,
the infraoccluded deciduous molar exfoliated eventually and the underlying premolar erupted
spontaneously. In some severe phenotypes (10%), the infraoccluded deciduous molar was
extracted and space was regained to allow uncomplicated eruption of the associated premolar.
Conclusion: Statistically significant associations were observed between the presence of
infraocclusion and the occurrence of tooth agenesis, microdontia of maxillary lateral incisors,
PDC, and MnP2-DA. These associations support a hypothesis favoring shared causal genetic
factors. Clinically, infraocclusion may be considered an early marker for the development of later
appearing dental anomalies, such as tooth agenesis and PDC.
Quinidine, Albino rats, Pentylenetetrazole, Gap junctionsiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
8th publication - Dr Rahul VC Tiwari - Department of oral and Maxillofacial Surgery, SIBAR Institute of Dental Sciences, Takkellapadu,Guntur, Andhra Pradesh - 522509.
Dr. Rahul VC Tiwari - Fellowship In Orthognathic Surgery - Jubilee Mission Medical College Hospital and Research Center, Thrissur, Kerala - 20TH PUBLICATION - IJADS
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
En masse retraction and two step retraction of maxillary /certified fixed ort...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
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1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. S80 Christie, Boucher, and Chung American Journal of Orthodontics and Dentofacial Orthopedics
April 2010
especially the first premolars compared with the tooth-
borne expander. Kilic et al13
reported that both hyrax
(tooth borne) and acrylic bonded (tooth tissue-borne)
palatal expanders produced significant buccal tipping of
supporting teeth, but the amount of tipping was less in
the tooth tissue-borne appliance.
The purpose of this study was to use CBCT to exam-
ine the effects of RPE on the widths of the nasal cavity,
maxillary basal bone, and midpalatal suture, and the in-
clination of maxillary first molars with a bonded Haas-
type expander.
Material and methods
Twenty-four healthy children (mean age, 9.9 years;
range, 7.8-12.8 years; 14 boys, 10 girls) who required
RPE treatment, from a private orthodontic practice,
were included for the study. The skeletal age of each
patient was determined from a hand-wrist radiograph,
according to the standards of Greulich and Pyle.14
The
mean skeletal age of the patients was 10.3 years (range,
7.5-13 years).
A pretreatment CBCT image (T1) was taken as part
of the initial orthodontic records of all patients. The scans
were obtained with an I-CAT machine (Imaging Sciences
International, Hatfield, Pa). For each patient, a bonded
Haas-type maxillary expander was cemented in place. The
design of the expander was full occlusal and palatal acrylic
coverage. The occlusal coverage included the deciduous
canine (or the permanent canine if in the arch) through
to the first molar (Fig 1). The appliances were all made
by the same orthodontic laboratory. Before cementation,
2 small holes were drilled on either side of the expander
in both anterior and posterior regions. Once the expander
was cemented in place, the distance between the 2 holes
was measured with a digital caliper. Expansion was carried
out as 2 turns per day (0.2 mm per turn) until the required
expansion was complete.
An immediate postexpansion CBCT image (T2)
was taken of each patient on the day the appliance
was tied off when adequate expansion was achieved.
To decrease the amount of radiation, the posttreatment
scan had a smaller window, which decreased the imag-
ing time from 20 to 10 seconds and halved the amount
of radiation. A digital caliper was used to measure the
distance between the 2 acrylic halves after expansion.
The amount of activation of the jackscrew was mea-
sured by averaging the difference in distance between
the T1 and T2 images in the anterior and posterior
areas. The mean interval between the T1 and T2 was
66 days (range, 21-152 days), but the mean active ex-
pansion period (from beginning of expansion to T2)
was 30 days (range, 21- 42 days). None of the patients
cavity. However, Wertz and Dreskin7
reported that af-
ter RPE the midpalatal suture opening was not paral-
lel, with the widest opening at the anterior nasal spine
(ANS) and diminishing posteriorly. Using CT scanning,
Habersack et al8
found a parallel opening of the mid-
palatal suture in a young patient after RPE, whereas
an older patient had a pyramidal opening of the suture
with jigsaw-like rupture lines indicating greater suture
interdigitation. Silva Filho et al9
found that the posterior
nasal spine (PNS) opened to a lesser extent than did the
ANS in children in the deciduous and mixed dentition
stages on CT images after RPE. Podesser et al3,10
evalu-
ated the effects of RPE in 9 children using CT imaging.
They reported that the average expansion measured at
the molar crowns was 3.6 mm, whereas the actual mid-
palatal sutural opening was as low as 1.6 mm. Using
CBCT, Garrett et al5
found more skeletal expansion of
the maxilla in the first premolar region and less in the
first molar region: 55% and 38% of the hyrax appliance
expansion, respectively.
Chung and Font11
examined 20 adolescents expand-
ed with Haas-type expanders. They found that 9.7% of
interpremolar expansion and 4.3% of intermolar expan-
sion were due to buccal crown tipping, but the degree
of tipping was not determined because of the inability
to measure the axial inclination from PA cephalograms.
Haas12
suggested that more bodily movement and less
dental tipping were produced when acrylic palatal cov-
erage was added to support the appliance. Garib et al4
examined the dentoskeletal effects of tooth tissue-borne
and tooth-borne expanders, and concluded that RPE
led to buccal movement of the maxillary posterior teeth
by tipping and bodily translation in both groups. How-
ever, the tooth tissue-borne expander produced greater
changes in the axial inclination of the supporting teeth,
Fig 1. Bonded palatal expansion appliance. The occlu-
sal coverage included the deciduous canines (or per-
manent canines if in the arch) through the first molars.
S79-85_AAOPRG_3053.indd 80 3/24/10 12:08 PM
3. American Journal of Orthodontics and Dentofacial Orthopedics Christie, Boucher, and Chung S81
Volume 137, Number 4, Supplement 1
premolar if in the arch), first deciduous molar (or first pre-
molar if in the arch), and canine, respectively (Fig 3).
The same method was used for the left lateral view,
but using point 2 to make a horizontal reference line.
Points 7, 8, 9, and 10 were marked on the left lateral
view of the 3D skull on the horizontal reference line of
point 2 and above the center of the clinical crown of the
maxillary first molar, second deciduous molar (or sec-
ond premolar if in the arch), first deciduous molar (or
first premolar if in the arch), and canine, respectively.
Once points 1 through 10 were plotted on the 3D
skull, the axial section was brought into view to ensure
that all points were plotted on the alveolar bone. The
maxillary base width and the width of the suture open-
ing were calculated from the axial view.
The measurement of the width of the maxillary base
at the level of the maxillary first molars, second decidu-
ous molars, first deciduous molars, and canines were
measured as the distances between points 3 and 7, 4 and
8, 5 and 9, and 6 and 10, respectively (Fig 3).
On the T2 images, once the maxillary base width had
been recorded, the axial slice with points 1 through 10 plot-
ted was used to measure the width of the suture opening.
received any brackets or wires in the maxillary arch
until the CBCT images were taken at T2.
All CBCT images were oriented and standardized
by using Dolphin Imaging (version 10.5, Dolphin Imag-
ing & Management Solutions, Chatsworth, Calif). Each
head was oriented in 3 planes of space for frontal, right
lateral, and left lateral views. The head was oriented
in the frontal view with the floor of the orbits parallel
to the floor. The right lateral view allowed placement of
the head so that the Frankfort horizontal line (upper rim
of external auditory meatus, porion, to the inferior bor-
der of the orbital rim, orbitale) was parallel to the floor.15
Both the right and left posterior borders of the ramus
and the angle of the mandible were superimposed to the
best possible fit. The left lateral view was also examined
to ensure that the Frankfort horizontal was parallel to
the floor, and the borders of the ramus and the angle of
the mandible were superimposed as best fit.
The first set of data was calculated from the patient’s
3D skull view. Quantitative evaluation of the parame-
ters was based on the identification and registration of
a series of points. Points 1 and 2 were reference points
that represented the levels of basal bone of the maxilla.
These landmarks were plotted from the frontal view of
the skull on both sides. These landmarks were defined
as the most superior aspect of the concavity of the max-
illary bone as it joined the zygomatic process (Fig 2).
From point 1, a horizontal reference line parallel to the
floor was drawn. Points 3, 4, 5, and 6 were marked on the
right lateral view of the 3D skull on the horizontal refer-
ence line and above the center of the clinical crown of the
maxillary first molar, second deciduous molar (or second
Fig 2. Reference points 1 and 2 on the frontal view of
the skull, defined as the most superior aspects of the
concavity of the maxillary bone as it joined the zygo-
matic process.
Fig 3. Right lateral view of the skull showing the plotting
of points 3 through 6 by using a line passing through
point 1 and parallel to the floor as the horizontal refer-
ence line. Point 3 was marked on the same horizontal
plane as point 1 directly above the center of the clinical
crown of the maxillary first molar. Point 4 was marked on
the same horizontal plane as point 1 and directly above
the center of the clinical crown of the second deciduous
molar (or second premolar). Point 5 was marked on the
same horizontal reference plane as point 1 and directly
above the center of the clinical crown of the first decidu-
ous molar (or first premolar). Point 6 was marked on the
same horizontal reference plane as point 1 and directly
above the center of the clinical crown of the canine.
S79-85_AAOPRG_3053.indd 81 3/24/10 12:08 PM
4. S82 Christie, Boucher, and Chung American Journal of Orthodontics and Dentofacial Orthopedics
April 2010
Quantitative evaluation of the parameters was based
on the identification and registration of a series of points,
as suggested by Podesser et al.10
Points 1 and 2 were the
lateral limits of the nasal cavity: point 1 was the lateral
point on the lateral wall of the right nasal cavity with a line
perpendicular to the floor. Point 2 was constructed on the
lateral wall of the left nasal cavity from point 1 by using a
line perpendicular to the floor. Points 3 and 4 represented
the apices of the palatal roots of the first molars, right and
left, respectively. Points 5 and 6 represented the tips of the
mesiobuccal cusps of the maxillary first molars, right and
left, respectively (Fig 5). The following measurements
were taken on each coronal section.
1. On the first molar: (1) nasal cavity width, the dis-
tance between points 1 and 2; (2) right molar in-
clination, points 5 to 3 to the floor; (3) left molar
inclination, points 6 to 4 to the floor; and (4) inter-
molar angle, the angle of intersection of lines from
points 5 to 3 and points 6 to 4.
2. On the second deciduous molar (or second premolar):
nasal cavity width, the distance between points 1 and 2.
3. On the first deciduous molar (or first premolar): nasal
cavity width, the distance between points 1 and 2.
The image was adjusted at slice thickness distance 1.0 mm
until the entire suture opening could be seen. Points 11 and
12 were marked at the horizontal level of point 3, which
marked the maxillary right first molar. Point 11 was placed
on the right border of the suture, and point 12 was placed
on the left border of the suture. Point 13 was placed on the
right border of the suture following the horizontal line of
point 4 (right second deciduous molar), and point 14 was
placed on the left border of the suture in the same hori-
zontal plane. Point 15 was placed on the right border of
the suture following the horizontal line of point 5 (right
first deciduous molar), and point 16 was placed on the left
border of the suture in the same horizontal plane. Point 17
was placed on the right border of the suture following the
horizontal line of point 6 (right canine), and point 18 was
placed on the left border of the suture in the same horizon-
tal plane. The distances between points 11 and 12, 13 and
14, 15 and 16, and 17 and 18 were calculated, representing
the distances between the suture opening at the level of the
maxillary first permanent molar, second deciduous molar,
first deciduous molar, and canine, respectively (Fig 4).
The second set of data for the coronal sections was
collected and analyzed according to the guidelines of Po-
desser et al.10
For the molar slice, the most anterior slice
showing the entire palatal root of the maxillary first mo-
lar was chosen. The second deciduous molar (or second
premolar if present), and the first deciduous molar (or first
premolar if present) were chosen as the most anterior slice
on which the crown and root could be seen in their entire
length, regardless of whether the tooth was the deciduous
one or its permanent successor.
Point 3
Point 4
Point 5
Point 6
Point 7
Point 8
Point 9
Point 10
Point 11 Point 12
Point 13 Point 14
Point 15 Point 16
Point 17 Point 18
Fig 4. Axial slice showing how the suture opening was
recorded. Points 11 and 12 were plotted on the same
horizontal line as point 3, which represented the bas-
al bone of the maxillary right first molar. Point 11 was
placed on the right border of the suture, and point 12
was placed on the left border of the suture. The dis-
tance between points 11 and 12 was recorded as the
suture opening for the maxillary first molar. This process
was repeated for the second deciduous molar (second
premolar), first deciduous molar (first premolar), and ca-
nine by using the horizontal reference lines of points 4,
5, and 6, respectively.
Fig 5. Points 1 and 2 represented the lateral limits of the
nasal cavity. Point 1 was the lateral point on the lateral
wall of the right nasal cavity with a line perpendicular to
the floor. Point 2 was constructed on the lateral wall of
the left nasal cavity from point 1 by using a line perpen-
dicular to the floor. Points 3 and 4 represented the api-
ces of the palatal roots of the right and left first molars,
respectively. Points 5 and 6 represented the tips of the
mesiobuccal cusps of the maxillary right and left first
molars, respectively.
S79-85_AAOPRG_3053.indd 82 3/24/10 12:08 PM
5. American Journal of Orthodontics and Dentofacial Orthopedics Christie, Boucher, and Chung S83
Volume 137, Number 4, Supplement 1
Table I shows the increase in the width of the nasal
cavity at the level of the maxillary first molar and second
deciduous molar (or second premolar) after RPE. The
mean increases were 2.73 mm at the maxillary first mo-
lar and 3.06 mm at the maxillary second deciduous mo-
lar. Because the actual mean expansion from the bonded
expander was 8.19 mm, the nasal width expansions of
2.73 mm at the first molar and 3.06 mm at the second
deciduous molar were 33.23% and 37.32%, respectively.
The increases in the width of the basal bone of the
maxilla at all levels as a result of RPE are given in Table I.
The mean increases in basal bone width at the levels of the
maxillary first molar, second deciduous molar, first decidu-
ous molar, and canine were 40.65% (3.33 mm), 44.08%
(3.49 mm), 46.73% (3.83 mm), and 46.83% (3.62 mm) of
the amount of jackscrew opening (8.19 mm), respectively.
Table I also shows the increases in width of the mid-
palatal suture at all levels as a result of RPE. The mean
increases at the levels of the maxillary first molar, sec-
ond deciduous molar, first deciduous molar, and canine
were 52.82% (4.33 mm), 53.23% (4.36 mm), 54.35%
(4.46 mm), and 52.77% (4.33 mm) of the amount of
jackscrew opening (8.19 mm), respectively. There was
no significant difference for suture opening at each level
(P 0.05). This demonstrated the parallel effect of the
suture opening across all levels.
A statistically significant increase (11.82° ± 3.07°)
was seen in the intermolar angle after expansion, with
6.22° ± 2.5° of buccal tipping on the right first molar
and 5.60° ± 2.6° of buccal tipping on the left first mo-
lar (Table II).
Discussion
The objective of this study was to evaluate the ef-
fects of bonded RPE on nasal width, maxillary basal
bone, midpalatal suture opening, and first molar tipping
with CBCT. The mean time from the T1 to the T2 CT
images was 66 days (range, 21-152 days), but the mean
Statistical analysis
Descriptive statistics including means, standard devia-
tions, and ranges were calculated for the measurements at
T1 and T2. The Student paired t test was used to evalu-
ate whether the changes from T1 to T2 were significantly
different. To test intraexaminer reproducibility, all images
were remeasured by the same examiner (K.F.C.) a mini-
mum of 2 weeks later and compared with the original mea-
surements. The paired t test and the Pearson correlation
coefficients were run to determine whether the measure-
ments at the 2 times showed significant differences. To test
interexaminer reproducibility, 12 patients were selected at
random and measured by an orthodontic resident. The Stu-
dent paired t test and the Pearson correlation coefficients
were run to determine whether the measurements by the 2
examiners showed significant differences. Significance for
all statistical tests was predetermined at P 0.05.
Results
The intraexaminer reproducibility test showed that
only 2 (nasal cavity width at the second deciduous mo-
lar and intermolar angulation) of the 24 measurements
had significant differences (P 0.05). However, in each
case, the Pearson correlation coefficient varied between
0.99 and 0.97, indicating high reproducibility among
measurements, and the magnitudes of the difference
were only 0.26 mm and 0.33°, respectively.
The interexaminer reproducibility test showed that
5 (basal bone width of the maxillary first molar at T1,
right molar angulation at T1, left molar angulations at
T1 and T2, intermolar angulation at T2, and midpalatal
suture opening at the first deciduous molar [or first
premolar] at T2) of the 24 measurements had statisti-
cally significant differences (P 0.05). In each case, the
Pearson correlation coefficient varied between 0.98 and
0.99, indicating high reproducibility among measure-
ments. The differences were 0.84 mm, 0.78 mm, 1.33°,
1.08°, 0.38°, and 0.03 mm, respectively.
Table I. Changes in nasal cavity, basal bone of the maxilla, and midpalatal suture after bonded RPE
n
Mean difference,
T1-T2 (mm) SD (mm) Range (mm)
Mean/mean screw
expansion (%) P value
Nasal cavity First molar 24 2.73 0.92 0.75–4.35 33.23 0.00001
Second deciduous molar 24 3.06 0.88 1–4.65 37.32 0.00001
Basal bone of maxilla First molar 24 3.33 1.32 .5–5.45 40.65 0.00001
Second deciduous molar 24 3.49 2.02 .03–6.1 44.08 0.00001
First deciduous molar 24 3.83 1.46 0.2–5.45 46.73 0.00001
Canine 24 3.62 2 0.7–8 46.83 0.00001
Midpalatal suture First molar 24 4.33 1.19 1.9–7.25 52.82 0.00001
Second deciduous molar 24 4.36 1.27 1.9–8.2 53.23 0.00001
First deciduous molar 24 4.46 1.11 2.15–7.3 54.35 0.00001
Canine 24 4.33 1.06 2.7–6.2 52.77 0.00001
S79-85_AAOPRG_3053.indd 83 3/24/10 12:08 PM
6. S84 Christie, Boucher, and Chung American Journal of Orthodontics and Dentofacial Orthopedics
April 2010
opening at the level of the teeth, whereas in previous stud-
ies, such as that of Wertz and Dreskin,7
the measurements
were at ANS and PNS.
Because of the previous limitations in technology,
the amount of basal bone change after RPE was never
clearly understood at the levels of the maxillary first
molar, second deciduous molar (second premolar if
present), first deciduous molar (first premolar if pres-
ent), and canine. Traditionally, the width of the max-
illary basal bone was measured on a PA cephalogram.
The radiographic landmark of jugale was plotted on PA
cephalograms and defined as the intersection of the out-
line of the tuberosity of the maxilla and the zygomatic
buttress of both sides.16
The distance between right and
left jugales was used to estimate the transverse dimen-
sion of the maxilla. However, jugale can be hard to
identify because of the superimposition of many struc-
tures on a PA cephalogram. There was also no way to
measure the width of the basal bone of the maxilla at
any other level because of the 2-dimensional limitations
of traditional PA cephalograms. CBCT allowed us to
clearly visualize and quantify the changes throughout
the basal bone of the maxilla from palatal expansion.
Our data showed that all levels of the maxillary basal
bone examined were significantly increased (P 0.05)
after RPE.
Our data also showed a significant buccal crown tip-
ping effect on the first molars from RPE. Clinically, this
information is important, since it could help clinicians
to determine the appropriate amount of overexpansion
from RPE. The mean amounts of buccal tipping were
6.22° ± 2.5° for the right molar and 5.60° ± 2.6° for
the left molar; these amounts are similar to those found
by Ciambotti et al19
of 6.08° ± 6.25° of buccal crown
tipping of the maxillary molars after RPE using a tooth-
borne appliance on children and measured on dental
models. Oliveira et al20
examined the various effects of
a tissue-borne appliance (Haas) and a tooth-borne appli-
ance (hyrax) on children. The Haas group had more or-
thopedic movement and less dentoalveolar tipping than
did the hyrax group. Recently, Kilic et al13
compared
the dentoalveolar inclination of patients treated with ei-
ther a hyrax expander (mean skeletal age, 13.9 years)
or an acrylic bonded expander similar to the type used
in our study (mean skeletal age, 13.6 years) using study
active expansion period (from beginning of expansion
to T2) was only 30 days (range, 21-42 days). The reason
for the long interval between T1 and T2 was that some
patients did not start treatment until 3 or 4 months after
the T1 images (initial records) were taken. Thus, some
skeletal changes from T1 to T2 in this study could be
attributed to growth during this waiting period, although
the amount was estimated to be small.16-18
Our data clearly showed significant increases in na-
sal cavity width at the levels of the maxillary first molars
(mean, 2.73 mm; 33.23% of jackscrew expansion) and
the second deciduous molars (mean, 3.06 mm; 37.32% of
jackscrew expansion) after RPE. We did not measure the
width of the nasal cavity at the level of the first decidu-
ous molar and canine because of distortion of the coronal
image, since the section was taken more anteriorly. Our
results agreed with those of Garib et al,4
who reported that
the transverse increase at the level of the nasal floor cor-
responded to one-third of the amount of jackscrew expan-
sion after RPE. We measured the lateral limits of the nasal
cavity, which was at a higher level than the nasal floor as
described by Garib et al.4
This finding might support the
theory that maxillary expansion increases air flow and
improves nasal breathing.1,6,11,12,19
However, additional re-
search is warranted in terms of how the volume of the nasal
airway is affected by RPE.
We found that, as a result of RPE, the midpalatal suture
opened in a parallel fashion. This was different from the
results of Wertz and Dreskin,7
who used occlusal films and
described the opening to be the widest at ANS and dimin-
ished posteriorly after RPE in subjects aged 8 to 29 years.
This was also different from the CT study by Silva Filho
et al,9
who reported that the opening of the midpalatal su-
ture in the area of the PNS occurred to a lesser extent than
at ANS after RPE with a Haas-type expander in subjects
from 5.2 to 10.5 years of age. Our results compare with
those of Habersack et al,8
who used CT imaging to demon-
strate complete parallel opening of the midpalatal suture in
a child in the mixed dentition (skeletal age, 10 years) after
RPE with an acrylic splint expansion appliance. Perhaps
the parallel nature of the midpalatal suture opening seen
at the levels of canine through the maxillary first molar in
this study was due to a combination of the rigid acrylic
bonded expander and the younger skeletal age (mean, 10.3
years) of our patients. In our study, we measured the suture
Table II. Tipping effects on maxillary first molars after bonded RPE
n
Mean difference, T1-T2
(°) SD (°) Range (°) P value
Right molar angulation 24 6.22 2.5 2.2–11.7 0.00001
Left molar angulation 24 5.6 2.6 0.95–10.65 0.00001
Intermolar angle 24 11.82 3.07 3.4–17.05 0.00001
S79-85_AAOPRG_3053.indd 84 3/24/10 12:08 PM
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RA. Rapid maxillary expansion—tooth tissue-borne versus tooth-
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skeletal effects. Angle Orthod 2005;75:548-57.
5. Garrett BJ, Caruso JM, Rungcharassaeng K, Farrage JR, Kim JS,
Taylor GD. Skeletal effects to the maxilla after rapid maxillary
expansion assessed with cone-beam computed tomography. Am J
Orthod Dentofacial Orthop 2008;134:8-9.
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thopedics. Am J Orthod 1970;57:219-55.
7. Wertz R, Dreskin M. Midpalatal suture opening: a normative
study. Am J Orthod 1977;71:367-81.
8. Habersack K, Karoglan A, Sommer B, Benner KU. High-resolu-
tion multislice computerized tomography with multiplanar and
3-dimensional reformation imaging in rapid palatal expansion.
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9. Silva Filho OG, Silva Lara T, Almeida AM, Silva HC. Evaluation
of the midpalatal suture during rapid palatal expansion in chil-
dren: a CT study. J Clin Pediatr Dent 2005;29:231-8.
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of transverse maxillary dimensions using computed tomogra-
phy: a methodological and reproducibility study. Eur J Orthod
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11. Chung CH, Font B. Skeletal and dental changes in the sagittal,
vertical, and transverse dimensions after rapid palatal expansion.
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12. Haas AJ. The treatment of maxillary deficiency by opening the
midpalatal suture. Angle Orthod 1965;35:200-17.
13. Kilic N, Kiki A, Oktay H. A comparison of dentoalveolar inclina-
tion treated by two palatal expanders. Eur J Orthod 2008;30:67-72.
14. Greulich WW, Pyle SI. Radiographic atlas of skeletal develop-
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versity Press; 1959.
15. Proffit W, Fields H. Contemporary orthodontics. 3rd ed. St Louis:
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19. Ciambotti C, Ngan P, Durkee M, Kohli K, Kim H. A compari-
son of dental and dentoalveolar changes between rapid palatal
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J Orthod Dentofacial Orthop 2001;119:11-20.
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Orthop 2004;126:354-62.
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models. They determined that both types of expander
produced significant tipping, but the dentoalveolar in-
clination was greater in the hyrax group. They reported
tipping amounts with means of 7.01° for the right mo-
lar and 6.79° for the left molar with a mean jackscrew
opening of 7.31 mm in the acrylic bonded group. These
results were slightly higher than our findings.
We found that, after RPE, at the level of the first mo-
lar, the mean nasal cavity width increase was 2.73 mm,
the mean basal bone width increase was 3.33 mm,
and the mean suture opening was 4.33 mm. This dem-
onstrated that the expansion had a triangular pattern,
with the greatest increase in the suture, followed by bas-
al bone width and the nasal cavity width. Previous stud-
ies reported similar patterns in the expansion of skeletal
structures after RPE.2,6,11,21,22
Conclusions
The effects of bonded RPE (mean jackscrew open-
ing, 8.19 mm) on the transverse dimensions of the max-
illa in children, examined by CBCT, are as follows.
1. There were significant nasal width increases (P
0.05) at the levels of the maxillary first molar and
second deciduous molar (second premolar if pres-
ent) with means of 33.23% (2.73 mm) and 37.32%
(3.06 mm) of the jackscrew opening, respectively.
2. There were significant increases in the width of the
basal bone (P 0.05) at the levels of the first molar,
second deciduous molar (second premolar if pres-
ent), first deciduous molar (first premolar if pres-
ent), and canine with means of 40.65% (3.33 mm),
44.08% (3.49 mm), 46.73% (3.83 mm), and 46.83%
(3.62 mm) of the jackscrew opening, respectively.
3. There were significant midpalatal suture open-
ings (P 0.05) at the levels of the first molar, sec-
ond deciduous molar (second premolar if present),
first deciduous molar (first premolar if present),
and canine with means of 52.82% (4.33 mm),
53.23% (4.36 mm), 54.35% (4.46 mm), and 52.77%
(4.33 mm) of the jackscrew opening, respectively.
The midpalatal suture opening was parallel.
4. There was significant buccal tipping of the first mo-
lars (P 0.05), with mean increases of 6.2° for the
right molar and 5.6° for the left molar.
We thank Solomon Katz and Sonal Dave for their help.
References
1. Haas AJ. Rapid expansion of the maxillary dental arch and
nasal cavity by opening the midpalatal suture. Angle Orthod
1961;31:73-90.
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