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.
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.
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.
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.)
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.
Effects of bonded rapid palatal expansion on the transverse dimensions of the...EdwardHAngle
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).
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.
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.
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.)
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.
Effects of bonded rapid palatal expansion on the transverse dimensions of the...EdwardHAngle
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).
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.
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.
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.
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.
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.
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.
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.
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.
Digital workflow in full mouth rehabilitation using CBCTApurva Thampi
This is a journal club presentation on the digital workflow of a full mouth rehabilitation using implants and as CBCT as a guide.
The presentation and all the materials collected is available on request. Mail me at apurvathampi@gmail.com
Dental and Skeletal changes after intraoral molar distalization with sectiona...Maen Dawodi
Dental and Skeletal changes after intraoral molar distalization with sectional jig
The present study as conducted on 10 subjects to evaluate dental and skeletal changes after intraoral molar distalization. The maxillary molars were distalized with a sectional jig assembly. Sentalloy open coil springs were used to exert 150gm of force for a period of 12 weeks . A modified Nance appliance was the main source of anchorage. The pre-and postdistalization records included dental study casts clinical photographs and cephalograms.
A total of 665 readings recorded from lateral cephalograms and dental casts were subjected to statistical analysis . The mean distal movements of the 1st molar was 2.78mm, which was highly significant (p<0.001). It moved distally at the rate of 0.86mm/month. There was clinically some distal tipping (3.50degree) and distopalatal rotation (2.40 degree). These changes were statistically significant. This was the result of molar extrusion
(AJODO 1998 Vol 114: 319-27)
Class II malocclusion with mild to moderate space deficiency in the upper jaw can be treated in many different ways. One possibility is to distalize the maxillary 1st molars and to create space in the buccal segments for retraction of cuspids and anterior teeth.
Conventionally, extraoral traction has been used successfully for the correction of Class II malocclusion by restraining the forward growth of the maxilla, threby correcting the skeletal discrepancy.
These extraoral appliances are also capable of distalizing the maxillary molars to correct the dental discrepancies. These methods require considerable patient compliance. The forces exerted by this appliance are intermittent and hence require a prolonged treatment time.
In recent years , intraoral techniques have been found to be successful for maxillary molar distalization. Gianelly et al. reported distalization of maxillary molars using repelling magnet along with modified Nance appliance for anchorage control .He reported a rate of molar movement of 0.75 to 1mm./month.
Gianelly et al. also used Japanese Niti open coil spring in continuous arch wires and reported a mean molar movement of 1 to 1.5mm/month.
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.
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.
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.
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.
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.
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.
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.
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.
Digital workflow in full mouth rehabilitation using CBCTApurva Thampi
This is a journal club presentation on the digital workflow of a full mouth rehabilitation using implants and as CBCT as a guide.
The presentation and all the materials collected is available on request. Mail me at apurvathampi@gmail.com
Dental and Skeletal changes after intraoral molar distalization with sectiona...Maen Dawodi
Dental and Skeletal changes after intraoral molar distalization with sectional jig
The present study as conducted on 10 subjects to evaluate dental and skeletal changes after intraoral molar distalization. The maxillary molars were distalized with a sectional jig assembly. Sentalloy open coil springs were used to exert 150gm of force for a period of 12 weeks . A modified Nance appliance was the main source of anchorage. The pre-and postdistalization records included dental study casts clinical photographs and cephalograms.
A total of 665 readings recorded from lateral cephalograms and dental casts were subjected to statistical analysis . The mean distal movements of the 1st molar was 2.78mm, which was highly significant (p<0.001). It moved distally at the rate of 0.86mm/month. There was clinically some distal tipping (3.50degree) and distopalatal rotation (2.40 degree). These changes were statistically significant. This was the result of molar extrusion
(AJODO 1998 Vol 114: 319-27)
Class II malocclusion with mild to moderate space deficiency in the upper jaw can be treated in many different ways. One possibility is to distalize the maxillary 1st molars and to create space in the buccal segments for retraction of cuspids and anterior teeth.
Conventionally, extraoral traction has been used successfully for the correction of Class II malocclusion by restraining the forward growth of the maxilla, threby correcting the skeletal discrepancy.
These extraoral appliances are also capable of distalizing the maxillary molars to correct the dental discrepancies. These methods require considerable patient compliance. The forces exerted by this appliance are intermittent and hence require a prolonged treatment time.
In recent years , intraoral techniques have been found to be successful for maxillary molar distalization. Gianelly et al. reported distalization of maxillary molars using repelling magnet along with modified Nance appliance for anchorage control .He reported a rate of molar movement of 0.75 to 1mm./month.
Gianelly et al. also used Japanese Niti open coil spring in continuous arch wires and reported a mean molar movement of 1 to 1.5mm/month.
Tiwari R, Chakravarthi PS, Kattimani VS, Lingamaneni KP. A Perioral Soft Tissue evaluation after Orthognathic Surgery Using Three-Dimensional Computed Tomography Scan. The Open Dentistry Journal. 2018; 12:366-376. doi:10.2174/1874210601812010366.
omfs journal club ppt on bone ridge augmentationAkhil Sankar
This is a journal club to start with for new omfs pgs . This is correctly criticized and cross-checked ppt. Also, it is a relevant topic in day to day preactise
Journal club on Connective tissue graft associated or not with low laser ther...Shilpa Shiv
Connective tissue graft associated or not with low laser therapy to treat gingival recession: randomized clinical trial, Fernandes-Dias SB, de Marco AC, Santamaria Junior M et al.
JCP 2015.
An Evaluation of Short Term Success and Survival Rate of Implants Placed in F...DrHeena tiwari
An Evaluation of Short Term Success and Survival Rate of Implants Placed in Fresh Extraction Socket Post Prosthetic Rehabilitation- A Prospective Study
Long-Term Outcomes of Endoscopic Treatment for Bile Duct Stones in Patients A...JohnJulie1
There are limited data regarding the safety and efficacy of complete stone removal for the treatment of bile duct stones in elderly patients. Hence, this study evaluated the long-term outcomes of complete stone removal in elderly patients.
Long-Term Outcomes of Endoscopic Treatment for Bile Duct Stones in Patients A...JapaneseJournalofGas
There are limited data regarding the safety and efficacy of complete stone removal for the treatment of bile duct stones in elderly patients. Hence, this study evaluated the long-term outcomes of complete stone removal in elderly patients.
Calcaneal Lengthening Using Bone Substitute Graft for Neurological Flatfoot T...CrimsonPublishersOPROJ
Calcaneal Lengthening Using Bone Substitute Graft for Neurological Flatfoot Treatment by Mario Lampropulos* in Crimson Publishers: Orthopedic Research and Reviews Journal
Mandibular Symphyseal Distraction Osteogenesis and SARPE aao 2018 Washington ...Dr Sylvain Chamberland
SARPE and Mandibular Symphyseal Distraction Osteogenesis
Transverse skeletal deficiency is a common clinical problem associated with narrow basal and dentoalveolar bone. Bimaxillary transverse distraction osteogenesis for correction of OSA was first reported by Conley & Legan (2006). Mandibular symphyseal distraction osteogenesis (MSDO) evolve form tooth anchor device to bone anchor device for a better control of the distraction segment in the 3 planes of space. Its success depends on good collaboration between the orthodontist and the surgeon, and on strict patient selection. Throughout case reports, we will review the diagnosis, orthodontic and surgical treatment planning considerations to achieve clinical success.
Learning objective:
After this lecture you will be able to
1-Diagnose patient with transverse mandibular deficiency
2-Understand the distraction protocol
3-Manage the postdistraction orthodontic movement
To understand the pathophysiology of the arthrosis that lead to
condylar resorption.
To understand systemic, local and occlusal factors that may lead to condylar resorption.
To know the diagnostic test that are recommended.
To know how to adapt the treatment plan (surgical or nonsurgical) to patients with condylar resorption.
Case report of bilateral costochondral graft and alloplastic custom fit total joint replacement.
Facial asymmetry condylar hyperplasia or condylar hypoplasia (v a dgkfo)Dr Sylvain Chamberland
To differentiate non syndromic pathology that cause facial asymmetry.
To understand the effect of unilateral condylar hyperplasy in a growing and non-growing individual.
To Understand the effect of condylar fracture or trauma (impact) to the joint that may affect mandibular growth.
To know the diagnostic test and surgical treatment that is recommended.
Objectifs − Évaluer le rôle de l’âge sur la régénération osseuse par remodelage au niveau de la symphyse après génioplastie.
Méthode − Cinquante-quatre patients ayant bénéficié d’une génioplastie à la fin de leur traitement orthodontique ont été divisés en trois groupes selon leur âge au moment de l’intervention : moins de 15 ans (groupe 1), 15 à 19 ans (groupe 2) et 20 ans ou plus (groupe 3). Le groupe contrôle est constitué de 23 patients n’ayant pas désiré de génioplastie, suivis radiographiquement deux années après la fin de leur traitement. Les patients ont été évalués à trois moments : juste avant l’intervention (T1), juste après l’intervention (T2) et deux ans après l’intervention (T3).
Résultats − La quantité d’avancement mentonnier est identique pour les trois groupes, mais la quantité de remodelage osseux est plus importante pour le groupe 1, un peu moins notable pour le groupe 2 et encore moins pour le groupe 3 que pour le groupe 2. Pour les trois groupes, l’épaisseur de la symphyse a considérablement augmenté dans les deux années qui ont suivi l’intervention, mais la quantité d’os néoformé est bien plus importante dans le groupe 1 que dans le groupe 3. Le remodelage osseux, aussi bien au-dessus que derrière la symphyse déplacée, est également plus important chez les plus jeunes du fait de la croissance verticale des procès alvéolaires. Il n’y a aucune preuve d’un quelconque effet délétère de la génioplastie sur la croissance mandibulaire.
Conclusion − La génioplastie avec déplacement du segment mentonnier vers le haut et vers l’avant permet d’accroître l’épaisseur de l’os symphysaire, par apposition osseuse au-dessus du point B, ainsi qu’au niveau du point Gnathion. Lorsqu’elle est indiquée, la génioplastie doit être réalisée avant l’âge de 15 ans pour générer les meilleurs résultats en termes de remodelage osseux.
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.
Définir le moment optimal pour une génioplastie fonctionnelle en évaluant:
1-le patron du remodelage osseux au menton
2-le patron de stabilité post chirurgicale chez le patient adulte et celui en croissance.
Management of Class II correction device.
Lecture presented at McIntyre joint plenary program for doctors at the 66th Annual scientific session of the Canadian Association of Orthodontists, Montréal, september 2014
Class II correction devices are commonly used in orthodontics and exist in many declension. Literature reviews show that such devices do not appear to cause any significant changes in mandibular length and their effectiveness in correcting class II malocclusion can be explained by a combination of some skeletal (mainly maxillary) and dentoalveolar (maxillary and mandibular) modifications. The SUS2 corrector device will be presented using bondable head gear tube and self-ligating mandibular molar tube. A case presentaion will be used to explain how to use SUS2 device in a successful manner.
Condylar resorption orthodontic and surgical management perspectivesDr Sylvain Chamberland
The American Society of TMJ Surgeons proudly announces a unique and timely Continuing Education program.
The educational objective of this meeting will be to provide participating surgeons, orthodontists, and other community of interest attendees with the latest evidence-based information on this important and vexing subject.
The meeting format includes 3 sessions of focused presentations by invited speakers followed by a reactor panel and audience participation Q&A.
Objective: To understand the pathophysiology of the arthrosis that lead to condylar resorption. To understand systemic, local and occlusal factors that may lead to condylar resorption. To know the diagnostic test that are recommended. To know how to adapt the treatment plan (surgical or non surgical) to patients with condylar resorption.
Objective: To differentiate non syndromic pathology that cause facial asymmetry. To understand the effect of unilateral condylar hyperplasy in a growing and non growing individual. Understand the effect of condylar fracture or trauma (impact) to the joint that may affect mandibular growth. To know the diagnostic test and surgical treatment that is recommended.
Sarpe (2 stages) vs le fort 1 (single stage) approach to complex maxillary de...Dr Sylvain Chamberland
Orthognathic surgery seeks to correct maxillofacial deformities often associated with significant functional impairment. Procedures to alter the relationship of the jaws and teeth include osteotomies of the maxilla, mandible and chin. An understanding of the evolution of the principles and practices, combined with knowledge of recent advances in surgical technique and technology, helps the clinician effectively treat challenging problems. Interdisciplinary treatment planning, backed by strategies to manage complications, are necessary components of effective Orthognathic surgery.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Short term and long-term stability of surgically assisted rapid palatal expansion revisited ajodo2011-139_815-22
1. ORIGINAL ARTICLE
Short-term and long-term stability of surgically
assisted rapid palatal expansion revisited
Sylvain Chamberlanda and William R. Proffitb
Qubec, Qubec, Canada, and Chapel Hill, NC
e e
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 max-
imum 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 0.0001) was observed between the amount of relapse after SARPE and the post-
treatment 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. (Am J Orthod Dentofacial Orthop 2011;139:815-22)
A
lthough a number of articles on the stability of in Qubec, Canada. All had dental casts and posteroante-
e
surgically assisted rapid palatal expansion rior (PA) cephalograms immediately before SARPE (T1),
(SARPE) have been published, the reported sta- at the completion of expansion (T2), and at the removal
bility varies considerably.1-8 It is apparent that most of the expander approximately 6 months later (T3). As of
conclusions about the stability of SARPE depend on the end of January 2010, 32 had the same records before
what was measured and when the measurements were any second surgical phase (T4), 37 had records at the
made during the sequence of treatment. The goal of completion of orthodontic treatment (T5), and 23 had
this article was to present further longitudinal data for records 2 years after the end of orthodontic treatment
short-term and long-term stability, following up our (T6). Treatment characteristics are described in Table I.
previous article in the surgery literature with a larger A tooth-borne expansion device (Superscrew Super-
sample and 2 years of stability data.9 spring, Highwood, Ill), either banded (n 5 21) or bonded
with occlusal coverage (n 5 17) was used (Fig 1).
The surgical technique (described in detail previously)
MATERIAL AND METHODS included separation of the pterygoid junction and the
Thirty-eight patients, 19 females and 19 males be- midpalatal suture between the incisors’ roots.9 All
tween 15 and 54 years of age, agreed to participate in surgery was performed by the same surgeon.
a prospective, observational study of SARPE outcomes After the surgery, a latency period of 7 days was ob-
approved by the Ethics Committee of Laval University served, and then the patients were instructed to activate
the screw by 0.25 mm twice a day. The patients were
a
Private practice, Qubec, Qubec, Canada.
e e monitored twice a week until the planned expansion
b
Kenan Professor, Department of Orthodontics, University of North Carolina, was achieved 14 to 21 days later. Active orthodontic
Chapel Hill.
The authors report no commercial, proprietary, or financial interest in the prod- treatment for the maxillary dentition began 2 months
ucts or companies described in this article. after expansion had stopped. The expansion device
Supported in part by NIH grant DE-05221 from the National Institute of Dental was kept in place for approximately 6 months. In the
and Craniofacial Research.
Reprint requests to: Sylvain Chamberland, 10345 Boulevard de l’Ormire, e mandibular arch, orthodontic alignment of the teeth
Qubec, Qubec, Canada G2B 3L2; e-mail, drsylchamberland@biz.videotron.ca.
e e began 1 week to 2 months before SARPE.
Submitted, revised and accepted, April 2010. After the removal of the expander, no other retention
0889-5406/$36.00
Copyright Ó 2011 by the American Association of Orthodontists. except the main archwire was used until the end of or-
doi:10.1016/j.ajodo.2010.04.032 thodontic treatment. When the braces were removed,
815
2. 816 Chamberland and Proffit
Table I. Treatment characteristics of the experimental sample
Observation time point n Mean time (mo) SD Minimum Maximum
T1-T2 (distraction completed) 38 0.68 0.23 0.46 1.81
T2-T3 (expander retention) 38 5.95 0.68 4.21 7.13
T1-T4 (start to second surgery) 32 15.27 3.99 9.40 24.28
T2-T5 (end of expansion to deband) 37 21.59 5.28 12.88 41.69
T3-T5 (expander out to deband) 37 15.64 5.09 7.79 35.19
D1-T5 (total treatment time) 37 23.57 5.27 15.41 43.07
T5-T6 (postorthodontic treatment) 23 25.35 4.49 20.96 39.49
D1, Treatment initiated in the mandibular arch; T(x)-T(y), observation between 2 time points.
Fig 1. Superscrew for palatal expansion: A, with 2 molar bands and 2 bonded occlusal rests on the first
premolars; B, with bonded occlusal coverage. The bonded version was used for patients with an open
bite or a high mandibular plane angle to minimize downward-backward rotation of the mandible.
a bonded lingual wire was placed from canine to canine
in both arches. No removable retainers were used.
Of the 38 patients who completed the distraction
phase, 32 had a second surgical phase planned (usually
superior repositioning of the maxilla or mandibular ad-
vancement), but 4 of them did not need it after reassess-
ment. One patient was overexpanded and needed
constriction of the maxilla at the second surgical phase
to achieve arch coordination. His data were removed at
T5. Twenty-three patients so far have returned for
records 2 years after the end of orthodontic treatment.
On the PA cephalograms, posterior maxillary width
was measured as the distance between the bilateral jug-
ula points, and nasal width was measured across the
lowest wide part of the nasal cavity (Fig 2). The enlarge-
ment factor was assessed by using the width of the screw
in situ and compared with the width of the screw on the
PA cephalogram. On the dental casts, maxillary interca- Fig 2. Width measurements on PA cephalometric radio-
nine, interpremolar, and intermolar widths were mea- graphs used in this study. Maxillary (MX) width was mea-
sured as the distances between the cusp tips of the sured between jugula left (JL) and right (JR), with jugula
canines, mesial fossae of the premolars, and central fos- defined as the point on the jugal process at the intersec-
sae of the molars. Mandibular inter-first molar width was tion of the outline of maxillary tuberosity and the zygo-
measured in the central fossae. matic process. Nasal cavity (NC) width was measured
The statistical significance of changes between between the left and right points at the lowest part of the
baseline and posttreatment data was assessed by using maximum concavity of the piriform rim.
paired 2-sample t tests and repeated measures analysis
June 2011 Vol 139 Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
3. Chamberland and Proffit 817
Mean Dental Changes
8 Maximal Expansion T3 - T1
Relapse T5 - T3
7 Net Expansion T5 - T1
Long Term Relapse T6 - T5
5
Net Changes T6 - T1
4
mm
2
1
-1
-3
-4
Canine 1st Premolar 2nd Premolar 1st Molar 2nd Molar 1st Lower Molar, 1st Lower Molar,
Non Exo Subgroup Exo Subgroup
Teeth
Fig 3. Changes in arch width with SARPE. All maxillary changes were statistically significant from
zero. Changes for the mandibular first molars of subjects who did not have first premolar extractions
(Non Exo Subgroup) are significantly different from zero. Changes for the mandibular first molars in
the subgroup that had first premolar extractions (Exo Subgroup) showed moderate constriction,
although it was nonsignificant. The brackets on each bar show the standard error. See Appendix for
completed detailed changes.
of variance (ANOVA). The first test was used as a micro- RESULTS
investigation of any significant changes between 2 Dental changes, as measured on the dental casts
specific times, and the last test was used as a macroin- obtained at each time point, are shown in Figure 3
vestigation of the global evolution of the measure- and Appendix. The changes in the maxillary arch during
ments through more than 2 times. Since there were 6 expansion (T3-T1) and after expansion (T5-T3) were sig-
t tests for dental changes, the level of significance nificantly different from zero (P0.001), as were the net
was corrected by the Bonferroni adjustment (a 5 expansion amounts at debonding (T5-T1) and the
0.05/6) to prevent type 1 error. Moreover, unpaired 2-year recall (T6-T1). The amount of expansion at the
2-sample t tests were used to compared the means of second molars (7.36 mm) was similar to that at the first
dental or skeletal changes between the 2 types of ap- premolars (7.61 mm), showing the parallelism of maxil-
pliance (bonded, banded) or between the 2 subgroups lary expansion anteroposteriorly viewed from the occlu-
for the mandibular arch (extraction, nonextraction). sal aspect. Greater relapse was noted across the second
ANOVA models were also used to measure the effect molars; therefore, the net expansion at the second
of phase 2 surgery. After a significant effect, protected molar was significantly less than across the first premo-
least significant difference multiple comparisons were lars (P 5 0.0013). This can be explained by arch-form
used to test the differences between all pairs of surgery. coordination during treatment.
Finally, the association between dental and skeletal The mandibular arch changes should be interpreted
changes was investigated by using Pearson correlation cautiously. Eight patients had the first premolars ex-
coefficients. The method error was also evaluated on tracted in the mandibular arch for second stage surgery
dental changes at T6 for which the measurements preparation. Therefore, 2 subgroups were assessed ac-
were taken twice. To do so, the Shrout and Fleiss intra- cording to this variable. The nonextraction subgroup
class correlations were used as a coefficient of fidelity; with records at T5 (n 5 28) showed significant expan-
these were all greater than 0.99, indicating a small sion of mandibular intermolar width at debonding
method error. (2.45 6 2.18 mm; P 0.0001), whereas the extraction
American Journal of Orthodontics and Dentofacial Orthopedics June 2011 Vol 139 Issue 6
4. 818 Chamberland and Proffit
8.00
80
% Skeletal Expansion
80
6.00
Expansion (mm)
65 60
46 56
41
4.00
40
2.00
20
0.00 0
0.68 6.632 15.27 23.57 48.92
Time Point (Months)
(1st Molar) (% Mx/ M1) (Maxilla) (Nasal Cavity)
Fig 4. Changes over time after SARPE in the dental and skeletal dimensions, and in the percentages
of skeletal expansion. Almost all relapse was dental rather than skeletal. Repeated-measures ANOVA
confirmed a significant relationship between the amount of dental relapse and the time after surgery,
when skeletal changes are stable and unaffected by time after surgery. Squares indicate expansion
at the first molar. Diamonds indicate percentages of skeletal expansion at each time point. Circles in-
dicate maxillary skeletal expansion. Triangles indicate expansion across the nasal cavity.
subgroup (n 5 8) showed variable responses with a significant relationship (P 0.0001) between the
a tendency toward decreased intermolar width. amount of relapse seen after SARPE and when the post-
Figure 4 shows the changes over time in nasal treatment observation was made. Long-term data show
cavity width and skeletal maxillary width (see Fig 2 for that some relapse, although nonsignificant, continues to
the points that were measured). In both locations, signif- occur after orthodontic treatment. The exception was
icant expansion was obtained (P 0.0001) and post- the maxillary first molar, which reached the level of
SARPE change was negligible (P 5 0.1166). Therefore, significance. Thirty-nine percent of the patients with
the skeletal changes produced during SARPE can be con- 2 years of follow-up had more than 1 mm of relapse
sidered to be quite stable. across the first molars during those 2 years. For those
Table II shows that the 2 expansion devices had no 9 patients, the mean relapse was 2.2 mm.
significant difference in terms of expansion at the first Table IV shows that, of the different independent and
molar (P 5 0.2727), the skeletal level measured at jugula dependent variables assessed in this study, only 2 vari-
(P 5 0.2735), or the nasal cavity (P 5 0.3779). ables, the diastema at T2 and the change in length of
Of the 36 subjects whose treatments were completed the screw during expansion, were significantly correlated
by January 2010, 10 underwent a second-stage maxillo- with the amount of first molar expansion at T3. There
mandibular surgery for AP or vertical repositioning, 12 was no significant association between diastema width
had mandibular advancement only, 5 had maxillary sur- and net expansion, skeletal and dental changes, skeletal
gery only, and 9 did not need a second surgical phase. and screw length changes, relapse and molar expansion,
There was no significant effect of any phase 2 surgery or relapse and skeletal expansion.
on dental relapse (P 5 0.6637).
The data available at T3 to T4 and T5 (Table III) were
used to analyze the timing of dental relapse changes at DISCUSSION
the first molar. About 57% of the total relapse occurred The amount of expansion across the first molars from
during the first 9 months after expander removal, and the SARPE procedure was 7.60 6 1.57 mm. This was
43% occurred in the next 6 months. There was similar to other reports with measurements to the
June 2011 Vol 139 Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
5. Chamberland and Proffit 819
Table II. Effect of the type of appliance on expansion
Variable Type of appliance n Mean (mm) SD Minimum Maximum P value
First molar expansion Bonded 17 7.91 1.29 5.48 10.99 0.2727
Banded 21 7.34 1.75 4.95 10.98
Jugula expansion Bonded 17 3.88 1.98 2.00 8.90 0.2735
Banded 21 3.21 1.93 À1.40 6.40
Nasal cavity expansion Bonded 17 1.20 1.13 À1.10 3.60 0.3779
Banded 21 1.56 1.33 À1.10 4.20
Table III. Effect of the time on relapse after expander removal
Time-point comparison Relapse (mm) Error T or F value df P value
T3 vs T4 vs T5 vs T6 28.98 (F) 3, 125 0.0001
T3 vs T4 (9.5 6 3.2 mo) À1.05 0.30 3.53 (T) 125 0.0006
T4 vs T5 (5.7 6 1.5 mo) À0.79 0.30 2.62 (T) 125 0.0098
T3 vs T5 (15.2 6 5.1 mo) À1.85 0.29 6.43 (T) 125 0.0001
T5 vs T6 (24.7 6 3.1 mo) À1.09 0.34 3.23 (T) 125 0.0016
T(x) vs T(y), Difference between time point (x) and (y).
maximum expansion point.5,6,8,10 We noted a mean Table IV. Coefficient of correlation and determination
relapse in width that was significant for all dental cast between variables
dimensions from the canine to the second molar, with
a mean change of 1.83 6 1.83 mm at the first molar. Variable n r P value
This is a loss of 24% of the maximum expansion. As Diastema at T2 vs first 38 0.640 0.0001
molar expansion at T3
the large standard deviation indicates, there was
Diastema at T2 vs first 36 0.355 0.0334
considerable variation in the amount of relapse, which molar expansion at T5
is shown as the percentage of patients by amount of Diastema at T2 vs skeletal 38 0.217 0.1902
change in Figure 5. changes at T3
Posttreatment retention is likely to be an important Screw changes vs first 38 0.936 0.0001
molar expansion at T3
factor in any study of stability.7,10,11 In this study, the
Skeletal changes at T3 vs 38 0.338 0.0381
expansion device was maintained for 6 months after dental changes at T3
the distraction had stopped. Byloff and Mossaz,6 who Skeletal changes at T3 vs 38 0.295 0.0719
maintained the expander for 3 months and then replaced screw changes at T3
it with a conventional removable retainer for another Relapse T5-T3 vs first 36 À0.265 0.1186
molar expansion at T3
3 months, had 36% of relapse at the first molar at the
Relapse T5-T3 vs skeletal 36 À0.259 0.1271
end of orthodontic treatment. Progel et al,5 Berger expansion at T3
et al,7 Koudstaal et al,8 and de Freitas et al10 reported
0.88 mm (12%), 1.01 mm (17.5%), 0.5 mm (55%), and
1.48 mm (18%) of relapse, respectively, in a 12-month Our data showed that 42% of the patients had
study period. They concluded that expansion obtained a relapse of 2 mm, and 22% had a relapse greater
with SARPE is stable, but all their patients were still in than 3 mm at the first molar (Fig 5). This was similar
orthodontic treatment. In our study, data at T4 were col- to the stability reported with multi-segmented LeFort
lected 15 months after SARPE, before the second surgi- I osteotomy.9,12
cal phase for those who needed it. At that point, we Data at T6 were obtained 24.7 6 3.1 months after
found a mean of 1.04 mm of relapse at the first molar; the orthodontic treatment. Modest relapse after treat-
this was comparable with the above-mentioned studies. ment was observed. This was not statistically significant
This relapse at T4 was only 57% of the total relapse we for all teeth, except for the maxillary first molar (0.99 6
found. Therefore, any inferences about the stability of 1.1 mm; P 5 0.0003), where it represents 17% of the net
SARPE are questionable if arch form coordination or fi- expansion at T5 and adds to the relapse from T3 to T5.
nal AP or vertical relationships have not been achieved at This long-term relapse that was significant at the first
the time of measurement. molar only cannot be explained by a type 1 error, since
American Journal of Orthodontics and Dentofacial Orthopedics June 2011 Vol 139 Issue 6
6. 820 Chamberland and Proffit
SARPE: Post-Tx Changes
50.0
First Molar
45.0
First Premolar
40.0
% of Patients
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
( - 3) (-3 to -1) (-1 to 1) (1 to 3)
Relapse (mm)
Fig 5. Percentages of patients with major relapse (.3 mm), moderate relapse (1-3 mm), minimal
changes (À1-1 mm), and posttreatment expansion.
the level of significance was adjusted by the Bonferroni device.16-19 Koudstaal et al,8 in a prospective random-
method (a 5 0.05/6). It also cannot be explained by the ized patient trial comparing bone-borne and tooth-
effect of a bonded vs banded appliance, since our result borne devices, obtained 3.1 6 2.0 mm of expansion at
shows that the type of appliance had no effect on the alveolar crest and 2.6 6 1.8 mm at the nasal level,
relapse. Posttreatment arch form adjustment might be and found no difference in the efficacy of the 2 devices.
the explanation, since on the average the mandibular If one looks at the stability of the skeletal changes
intermolar distance was expanded and constricted with SARPE, it should rank high in the hierarchy of
modestly, and a large standard deviation was noted stability of orthognathic surgery, but if one looks at
(À0.18 6 1.5 mm). the dental changes, 64% of the patients had more
The amounts of dental expansion and the percent- than 2 mm of change and 22% had more than
ages of relapse in this study are in keeping with other 3 mm of change (Fig 5). This could be attributed to
long-term studies of SARPE.1-3,13,14 Bays and Greco2 several factors, such as the device itself, the surgical
reported 0.45 6 0.69 mm of relapse of the net expan- technique, or the timing of the observations, but for
sion at the first molar (7.7%) 2.4 6 1.3 years after treat- all other surgeries, presurgical orthodontic preparation
ment. Northway and Meade1 found 0.1 mm of relapse is done, and few if any dental movements are needed
of the net expansion (6%) 5 years after treatment. after surgery. This is not the case for SARPE. Many
Stromberg and Holm3 reported 1.2 6 1.3 mm of relapse dental movements, including correction of overexpan-
of the net expansion (8.3%) in a 3.5-year follow-up of sion, are done after the expander is removed to
a “selected sample.” Anttila et al4 reported an average achieve arch-form coordination. With SARPE, as with
relapse of 1.3 mm of the net expansion (22%) after other orthognathic surgical procedures, it is appropri-
6 years. ate to focus on skeletal, not dental, stability—which
In this study, immediately after SARPE, about half of has not been clearly reported previously because the
the expansion (46%) was skeletal, as shown by signifi- appropriate PA cephalograms were not available at
cant widening of the maxilla and the nasal cavity. This several time points.
was greater skeletal change than Byloff and Mossaz6 The significant correlation between the width of the
and Berger et al7 reported, perhaps because they diastema at T2 and the amount of first molar expansion
removed the expander after 3 months instead of our at T3 indicates that the development of a diastema is
6 months. Hino et al15 reported greater skeletal expan- a predictor that adequate molar expansion is occurring.
sion but used a landmark closer to the teeth than we If no diastema appears, one might suspect that there is
did. Recent computed tomography studies found skele- no separation of the hemimaxillae, and that the buccal
tal expansion from 5 to 7 mm with a tooth-borne segments are tipping.
June 2011 Vol 139 Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
7. Chamberland and Proffit 821
but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior
teeth.
Phase 2 surgery did not affect dental relapse. The di-
astema at the end of distraction is a predictor that ade-
quate molar expansion is occurring. Bonded expanders
showed the same efficacy as banded expanders.
We thank Dany Morais for careful surgical treatment
and Gaetan Daigle for statistical consultation and
analysis.
REFERENCES
1. Northway WM, Meade JB Jr. Surgically assisted rapid maxillary ex-
pansion: a comparison of technique, response, and stability. Angle
Orthod 1997;67:309-20.
2. Bays RA, Greco JM. Surgically assisted rapid palatal expansion: an
outpatient technique with long-term stability. J Oral Maxillofac
Surg 1992;50:110-5.
3. Stromberg C, Holm J. Surgically assisted, rapid maxillary expansion
Fig 6. PA cephalograms: A, before expansion; and B, af- in adults. A retrospective long-term follow-up study. J Craniomax-
illofac Surg 1995;23:222-7.
ter expansion. A, Inward movement of the alveolar edge
4. Anttila A, Finne K, Keski-Nisula K, Somppi M, Panula K,
below the buccal corticotomy (C); B, downward move- Peltomaki T. Feasibility and long-term stability of surgically assis-
ment of the palatal process of the hemimaxillae. ted rapid maxillary expansion with lateral osteotomy. Eur J Orthod
2004;26:391-5.
5. Pogrel MA, Kaban LB, Vargervik K, Baumrind S. Surgically assisted
We found that dental changes are not correlated with rapid maxillary expansion in adults. Int J Adult Orthod Orthognath
skeletal changes (r2 5 0.06); this is supported by the Surg 1992;7:37-41.
6. Byloff FK, Mossaz CF. Skeletal and dental changes following sur-
study of Goldenberg et al.18 This confirms that, in the gically assisted rapid palatal expansion. Eur J Orthod 2004;26:
frontal view, rotation of the hemimaxillae occurs, with 403-9.
teeth expanding more than bone8,9,17,20 and palatal 7. Berger JL, Pangrazio-Kulbersh V, Borgula T, Kaczynski R. Stability
depth decreasing.1,8 This means that the alveolar edges of orthopedic and surgically assisted rapid palatal expansion over
below the buccal corticotomy move inward, and the time. Am J Orthod Dentofacial Orthop 1998;114:638-45.
8. Koudstaal MJ, Smeets JB, Kleinrensink GJ, Schulten AJ, van der
palatal processes move downward as the dentoalveolar Wal KG. Relapse and stability of surgically assisted rapid maxillary
process is expanding (Fig 6). One might expect that expansion: an anatomic biomechanical study. J Oral Maxillofac
greater expansion during SARPE would mean greater Surg 2009;67:10-4.
relapse after removal of the expansion device. Our data 9. Chamberland S, Proffit WR. Closer look at the stability of surgically
show that there is no relationship between the amount assisted rapid palatal expansion. J Oral Maxillofac Surg 2008;66:
1895-900.
of expansion and the amount of dental relapse (r2 5 10. de Freitas RR, Goncalves AJ, Moniz NJ, Maciel FA. Surgically assis-
0.07, P 5 0.1186). ted maxillary expansion in adults: prospective study. Int J Oral
The classic study of the stability of transverse expan- Maxillofac Surg 2008;37:797-804.
sion obtained with segmented LeFort I osteotomy re- 11. Zimring JF, Isaacson RJ. Forces produced by rapid maxillary ex-
ported that patients who had concurrent mandibular pansion. 3. Forces present during retention. Angle Orthod 1965;
35:178-86.
surgery had significantly greater relapse at the first and 12. Proffit WR, Turvey TA, Phillips C. The hierarchy of stability and pre-
second molars.21 Our data showed no significant effect dictability in orthognathic surgery with rigid fixation: an update
of any phase 2 surgery on dental relapse. This might and extension. Head Face Med 2007;3:21.
be an important decision factor if large transverse 13. Marchetti C, Pironi M, Bianchi A, Musci A. Surgically assisted rapid
changes are necessary along with vertical and AP palatal expansion vs. segmental Le Fort I osteotomy: transverse sta-
bility over a 2-year period. J Craniomaxillofac Surg 2009;37:74-8.
changes. 14. Sokucu O, Kosger HH, Bicakci AA, Babacan H. Stability in dental
changes in RME and SARME: a 2-year follow-up. Angle Orthod
CONCLUSIONS 2009;79:207-13.
15. Hino CT, Pereira MD, Sobral CS, Kreniski TM, Ferreira LM. Trans-
In this study, transverse expansion of the maxilla was verse effects of surgically assisted rapid maxillary expansion:
achieved through SARPE with pterygoid plate separa- a comparative study using Haas and Hyrax. J Craniofac Surg
tion. Skeletal changes were modest (usually 3-4 mm) 2008;19:718-25.
American Journal of Orthodontics and Dentofacial Orthopedics June 2011 Vol 139 Issue 6
8. 822 Chamberland and Proffit
16. Loddi PP, Pereira MD, Wolosker AB, Hino CT, Kreniski TM, expansion: a computed tomography evaluation. Oral Surg Oral
Ferreira LM. Transverse effects after surgically assisted rapid Med Oral Pathol Oral Radiol Endod 2008;106:812-9.
maxillary expansion in the midpalatal suture using computed to- 19. Tausche E, Deeb W, Hansen L, Hietschold V, Harzer W,
mography. J Craniofac Surg 2008;19:433-8. Schneider M. CT analysis of nasal volume changes after
17. Landes CA, Laudemann K, Schubel F, Petruchin O, Mack M, Kopp S, surgically-assisted rapid maxillary expansion. J Orofac Orthop
et al. Comparison of tooth- and bone-borne devices in surgically 2009;70:306-17.
assisted rapid maxillary expansion by three-dimensional computed 20. Zemann W, Schanbacher M, Feichtinger M, Linecker A, Karcher H.
tomography monitoring: transverse dental and skeletal maxillary Dentoalveolar changes after surgically assisted maxillary expan-
expansion, segmental inclination, dental tipping, and vestibular sion: a three-dimensional evaluation. Oral Surg Oral Med Oral
bone resorption. J Craniofac Surg 2009;20:1132-41. Pathol Oral Radiol Endod 2009;107:36-42.
18. Goldenberg DC, Goldenberg FC, Alonso N, Gebrin ES, Amaral TS, 21. Phillips C, Medland WH, Fields HW Jr, Proffit WR, White RP Jr.
Scanavini MA, et al. Hyrax appliance opening and pattern of skel- Stability of surgical maxillary expansion. Int J Adult Orthod
etal maxillary expansion after surgically assisted rapid palatal Orthognath Surg 1992;7:139-46.
June 2011 Vol 139 Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics