The Open Dentistry Journal




ISSN: 1874-2106 ― Volume 14, 2020
RESEARCH ARTICLE

Mandibular Behavior after Rapid Maxillary Expansion: A Clinical Study



Radwan A. Haffaf1, *, Abdul-kareem Hasan1, Mohammad Tizini1
1 Department of Orthodontics, Faculty of Dentistry, Tishreen University, Lattakia, Syrian Arab Republic.

Abstract

Background:

Rapid Maxillary Expansion (RME) is a primary part of the contemporary orthodontic treatment plans. In addition to the maxilla, it is important to know its effect on the other dentofacial components. Some studies showed dentofacial changes after RME in the sagittal and vertical planes. The clinical importance of these changes is controversial.

Objective:

To investigate the mandibular changes after RME as the only treatment intervention in the sagittal and vertical planes.

Methods:

Twenty-eight growing patients aged 4-14 years were included in the current study. The bonded acrylic splint expander was used. Lateral cephalometric radiographs were taken at the beginning of the treatment (T1) and after a retention phase of six months (T2). The mandibular changes were assessed using vertical parameters (SN.MP, MMA, LAFH/TAFH, S.AR/AR.GO) and sagittal parameters (SNB, S.N.POG, N.A.POG). The changes between T1 and T2 were examined by paired samples T-test.

Results:

Two parameters showed a backward rotation in the vertical plane. The parameter S.AR/AR.GO showed a significant increase. The skeletal convexity increased with no clinical significance.

Conclusion:

There were statistically significant changes in the sagittal and vertical planes with no clinical importance. RME may affect the mandibular condyle position.

Keywords: Rapid maxillary expansion, Hyrax expander, Mandibular changes, Clinical study, Growth period, Maxillary deficiency.


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 537
Last Page: 543
Publisher Id: TODENTJ-13-537
DOI: 10.2174/1874210601913010537

Article History:

Received Date: 28/08/2019
Revision Received Date: 30/10/2019
Acceptance Date: 18/12/2019
Electronic publication date: 31/12/2019
Collection year: 2019

© 2019 Haffaf et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Department of orthodontics, Faculty of Dentistry, Tishreen University, Lattakia, Syrian Arab Republic;
E- mail: radwan.haffaf@yahoo.com






1. INTRODUCTION

Rapid Maxillary Expansion (RME) is a routinely used orthopedic treatment for many clinical conditions [1McNamara JA Jr, Franchi L, McClatchey LM. Orthodontic and orthopedic expansion of the transverse dimension: A four decade perspective. Semin Orthod 2019; 25: 3-15.
[http://dx.doi.org/10.1053/j.sodo.2019.02.002]
-3Moawad SG, Bouserhal J, Al-Munajed MK. Assessment of the efficiency of Erbium-YAG laser as an assistant method to rapid maxillary expansion: An in vivo study. Int Orthod 2016; 14(4): 462-75.
[http://dx.doi.org/10.1016/j.ortho.2016.10.015] [PMID: 27856377]
]. The earliest published paper was written by E.C. Angell (the father of rapid maxillary expansion) [4Angell EC. Treatment of irregularities of the permanent adult teeth. Dental Cosmos 1860; 1: 540-4.]. After the reintroduction of this procedure by Haas, RME has been commonly used in the field of orthodontics [5Haas AJ. The treatment of maxillary deficiency by opening the midpalatal suture. Angle Orthod 1965; 35(3): 200-17.
[PMID: 14331020]
, 6Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthod 1961; 31(2): 73-90.]. Several appliances have been introduced with new modifications in the expander or the appliance design. The bonded acrylic splint expander, Transverse Sagittal Maxillary Expander (TSME) [7Maspero C, Galbiati G, Giannini L, Farronato G. Sagittal and vertical effects of transverse sagittal maxillary expander (TSME) in three different malocclusion groups. Prog Orthod 2015; 16(25): 6.
[http://dx.doi.org/10.1186/s40510-015-0075-z] [PMID: 25907431]
], Ragno expander [8Çörekçi B, Göyenç YB. Dentofacial changes from fan-type rapid maxillary expansion vs traditional rapid maxillary expansion in early mixed dentition. Angle Orthod 2013; 83(5): 842-50.
[http://dx.doi.org/10.2319/103112-837.1] [PMID: 23387338]
], the memory screw [9Wichelhaus A, Geserick M, Ball J. A new nickel titanium rapid maxillary expansion screw. J Clin Orthod 2004; 38(12): 677-80.
[PMID: 15665443]
, 10Halicioğlu K, Kiliç N, Yavuz İ, Aktan B. Effects of rapid maxillary expansion with a memory palatal split screw on the morphology of the maxillary dental arch and nasal airway resistance. Eur J Orthod 2010; 32(6): 716-20.
[http://dx.doi.org/10.1093/ejo/cjp164] [PMID: 20403958]
], and the differential maxillary expander [11Garib D, Flores-Mir C, Normando D, Janson G, Miguel JA, Lindauer S. An interview with Daniela Garib. Dental Press J Orthod 2019; 24(1): 16-26.
[http://dx.doi.org/10.1590/2177-6709.24.1.016-026.int] [PMID: 30916245]
], have new mechanisms of action. Some concerns have been raised regarding the oral hygiene and food control in patients wearing orthodontic appliances [12Pithon MM, Dos Santos MJ, Andrade CS, et al. Effectiveness of varnish with CPP-ACP in prevention of caries lesions around orthodontic brackets: An OCT evaluation. Eur J Orthod 2015; 37(2): 177-82.
[http://dx.doi.org/10.1093/ejo/cju031] [PMID: 24997026]
], especially in patients with restorations [13Poggio C, Chiesa M, Scribante A, Mekler J, Colombo M. Microleakage in class II composite restorations with margins below the CEJ: In vitro evaluation of different restorative techniques. Med Oral Patol Oral Cir Bucal 2013; 18(5): e793-8.
[http://dx.doi.org/10.4317/medoral.18344] [PMID: 23722121]
, 14dos Santos RL, Pithon MM, Vaitsman DS, Araújo MT, de Souza MM, Nojima MG. Long-term fluoride release from resin-reinforced orthodontic cements following recharge with fluoride solution. Braz Dent J 2010; 21(2): 98-103.
[http://dx.doi.org/10.1590/S0103-64402010000200002] [PMID: 20640354]
] or those with incorrect behavior [15Poggio C, Dagna A, Chiesa M, Colombo M, Scribante A. Surface roughness of flowable resin composites eroded by acidic and alcoholic drinks. J Conserv Dent 2012; 15(2): 137-40.
[http://dx.doi.org/10.4103/0972-0707.94581] [PMID: 22557811]
]. However, some types of expanders are considered more hygienic than others [16Ortu E, Sgolastra F, Barone A, Gatto R, Marzo G, Monaco A. Salivary Streptococcus Mutans and Lactobacillus spp. levels in patients during rapid palatal expansion. Eur J Paediatr Dent 2014; 15(3): 271-4.
[PMID: 25306143]
].

Many studies investigated different aspects of the RME procedure. Some studies were histological [17Melsen B. Palatal growth studied on human autopsy material. A histologic microradiographic study. Am J Orthod 1975; 68(1): 42-54.
[http://dx.doi.org/10.1016/0002-9416(75)90158-X] [PMID: 1056143]
]. Others investigated the relapse [18Gurel HG, Memili B, Erkan M, Sukurica Y. Long-term effects of rapid maxillary expansion followed by fixed appliances. Angle Orthod 2010; 80(1): 5-9.
[http://dx.doi.org/10.2319/011209-22.1] [PMID: 19852633]
], stability [19Costa JG, Galindo TM, Mattos CT, Cury-Saramago AA. Retention period after treatment of posterior crossbite with maxillary expansion: A systematic review. Dental Press J Orthod 2017; 22(2): 35-44.
[http://dx.doi.org/10.1590/2177-6709.22.2.035-044.oar] [PMID: 28658354]
] and the side effects related to RME [20Guest SS, McNamara JA Jr, Baccetti T, Franchi L. Improving Class II malocclusion as a side-effect of rapid maxillary expansion: A prospective clinical study. Am J Orthod Dentofacial Orthop 2010; 138(5): 582-91.
[http://dx.doi.org/10.1016/j.ajodo.2008.12.026] [PMID: 21055598]
].

Increasing the Vertical Dimension (VD) after the maxillary expansion is a primary consideration in treatment planning [21Chang JY, McNamara JA Jr, Herberger TA. A longitudinal study of skeletal side effects induced by rapid maxillary expansion. Am J Orthod Dentofacial Orthop 1997; 112(3): 330-7.
[http://dx.doi.org/10.1016/S0889-5406(97)70264-6] [PMID: 9294364]
]. Some authors did not find any statistically significant increase [22Wendling LK, McNamara JA Jr, Franchi L, Baccetti T. A prospective study of the short-term treatment effects of the acrylic-splint rapid maxillary expander combined with the lower Schwarz appliance. Angle Orthod 2005; 75(1): 7-14.
[PMID: 15747809]
]. Others claimed that there was a statistically significant increase without any clinical importance [21Chang JY, McNamara JA Jr, Herberger TA. A longitudinal study of skeletal side effects induced by rapid maxillary expansion. Am J Orthod Dentofacial Orthop 1997; 112(3): 330-7.
[http://dx.doi.org/10.1016/S0889-5406(97)70264-6] [PMID: 9294364]
]. Lineberger stated that the VD increasing had no prejudicial effects on the vertical skeletal relationships. According to long term studies, it was a transient effect [23Lineberger MW, McNamara JA Jr, Baccetti T, Herberger T, Franchi L. Effects of rapid maxillary expansion in hyperdivergent patients. Am J Orthod Dentofacial Orthop 2012; 142(1): 60-9.
[http://dx.doi.org/10.1016/j.ajodo.2012.02.019] [PMID: 22748991]
].

A maxillary displacement after RME has been reported [24Davis WM, Kronman JH. Anatomical changes induced by splitting of the midpalatal suture. Angle Orthod 1969; 39(2): 126-32.
[PMID: 5252050]
]. Mandibular displacement is more controversial, keeping in mind that the mandible is the dynamic part of the dentofacial structures. Some authors reported an anterior mandibular displacement, which improved class II malocclusion, either through dental casts studies [25McNamara JA Jr, Sigler LM, Franchi L, Guest SS, Baccetti T. Changes in occlusal relationships in mixed dentition patients treated with rapid maxillary expansion. A prospective clinical study. Angle Orthod 2010; 80(2): 230-8.
[http://dx.doi.org/10.2319/040309-192.1] [PMID: 19905846]
] or by cephalometric evaluation [20Guest SS, McNamara JA Jr, Baccetti T, Franchi L. Improving Class II malocclusion as a side-effect of rapid maxillary expansion: A prospective clinical study. Am J Orthod Dentofacial Orthop 2010; 138(5): 582-91.
[http://dx.doi.org/10.1016/j.ajodo.2008.12.026] [PMID: 21055598]
]. The “foot and shoe” theory and the “spontaneous correction of class II malocclusion” phenomenon were introduced [26An interview with James A. McNamara Jr. Dental Press J Orthod [Internet] 2011; 16(3): 32-53.http://www.scielo.br/scielo.php?script= sci _arttext&pid=S2176-94512011000300004&lng=en.
[http://dx.doi.org/10.1590/S2176-94512011000300004]
]. In fact, these had been pointed in the German literature since the early 1900s by korbitz [26An interview with James A. McNamara Jr. Dental Press J Orthod [Internet] 2011; 16(3): 32-53.http://www.scielo.br/scielo.php?script= sci _arttext&pid=S2176-94512011000300004&lng=en.
[http://dx.doi.org/10.1590/S2176-94512011000300004]
, 27körbitz A. Kursus der systematischen Orthodontik Ein Leitfadenfür Studium und Praxis 2nd ed. 1914.]. However, the mandibular backward rotation induced by the maxillary expansion has been described [28da Silva Filho OG, Boas MC, Capelozza Filho L. Rapid maxillary expansion in the primary and mixed dentitions: a cephalometric evaluation. Am J Orthod Dentofacial Orthop 1991; 100(2): 171-9.
[http://dx.doi.org/10.1016/S0889-5406(05)81524-0] [PMID: 1867168]
].

Despite the large number of clinical studies that investigated the effects of RME, there is a lack of information regarding patients treated by RME as the only treatment intervention. The aim of this study was to investigate the mandibular sagittal and vertical changes subsequent to rapid maxillary expansion.

2. MATERIALS AND METHODS

The lateral cephalograms used in this study were obtained from a previous thesis and no patient was treated, especially for this article. The sample consisted of twenty-eight patients (16 males and 12 females) with indications for transverse expansion aged 4-14 years [9 ± 1.12], and without needing any mandibular intervention during the activation and retention periods. To determine the sample size, G*Power 3.1 (Heinrich-Heine-Universitat, Dusseldorf, Germany) program was used based on the results of a similar previous study [29Conroy-Piskai C, Galang-Boquiren MTS, Obrez A, et al. Assessment of vertical changes during maxillary expansion using quad helix or bonded rapid maxillary expander. Angle Orthod 2016; 86(6): 925-33.
[http://dx.doi.org/10.2319/112315-799] [PMID: 27182780]
]. Including a control group was unfeasible due to ethical reasons. It is unethical not to intervene when a diagnosed transverse discrepancy is present [30Baratieri C, Alves M Jr, Bolognese AM, Nojima MCG, Nojima LI. Changes in skeletal and dental relationship in Class II Division I malocclusion after rapid maxillary expansion: A prospective study. Dental Press J Orthod 2014; 19(3): 75-81.
[http://dx.doi.org/10.1590/2176-9451.19.3.075-081.oar] [PMID: 25162569]
].

The inclusion criteria were:

  • Maxillary constriction.
  • Posterior crossbites.
  • Class III face mask therapy [phase one].
  • Functional therapy of class II [phase one].

Exclusion criteria were:

  • Previous orthodontic treatment.
  • Syndromes or congenital disorders.
  • Class II division two.
  • Asymmetries in another plane.
  • Need for mandibular orthodontic intervention.

This study was conducted according to the World Medical Association (WMA) guidelines (Fortalenza, Brazil, October 2013). Patient health and safety were the primary considerations [31World Medical Association Declaration of Helsinki, Ethical Principles for Medical Research Involving Human Subjects. 64 WMA General Assembly 2013 October; ]. Informed consents were performed. Lateral cephalometric radiographs (Cranex® Excel Ceph, Soredex, Tuusula, Finland) were taken before treatment (T1). The appliance design was similar to McNamara design (bonded rapid maxillary expander with occlusal acrylic coverage), as shown in Fig. (1). Hyrax® expander (Dentaurum, Pforzheim, Germany) was used. The expander was activated one turn per day until the palatal maxillary cusps reach the buccal mandibular cusps. Overcorrection of 2-3 millimeters was gained. The overcorrection was visually estimated. The appliance was left in place during the retention phase. The average retention period ranged from 164 to 192 days (178 ± 7). After the retention phase, lateral cephalograms were taken (T2).

Fig. (1)
The bonded hyrax appliance


2.1. Cephalometric Analysis

Lateral cephalograms were exported as DICOM (Digital Imaging and Communications in Medicine) files. They were digitized using Facad cephalometric software (Ilexis AB, Sweden) installed on x64-based PC (Hewlett-Packard, Palo Alto, California, USA) running the windows 10 professional edition (Microsoft, Redmond, Wash). Five cephalograms were digitized in every session. Frankfort plane was rotated to be horizontal before landmarks identification. The auto-contrast function was used for almost every point detection. The vertical assessment was based on: SN-MP, MMA, LAFH /TAFH, S.AR/AR.GO. The sagittal assessment was based on: SNB, S.N.POG, N.A.POG. Ten cephalograms were digitized one month later to test the intraoperator reliability. Table 1 shows the definition of the used landmarks.

The variables shown in Fig. (2) (The vertical parameters) and Fig. (3) (The sagittal parameters) were defined as follows:

  • SN.MP: The angle formed between the anterior cranial base [S.N] and the mandibular plane [line between menton and constructed Gonion].
  • MMA: The angle formed between the nasal line [ANS, PNS] and the mandibular plane [ME. GO].
  • LAFH: The vertical distance from Menton to the anterior nasal spine.
  • TAFH: The vertical distance from Menton to Nasion.
  • S.AR/AR.GO: The ratio between the posterior cranial base [representd as a line from S to AR] and the hight of mandibular ramus [a line from AR to constructed gonion]
  • SNB angle: Angle formed by points S, N and B
  • S.N.Pog angle: Angle formed by points S, N and Pogonion
  • N.A.Pog angle: Angle formed by points N, A and pogonion
Fig. (2)
The vertical parameters.


Fig. (3)
The sagittal parameters.


Table 1
Definition of landmarks.


2.2. Statistical Analysis:

Intraoperator reliability was examined by the correlation coefficient test. In addition, the Bland-Altman method was used. Treatment changes were examined by paired samples t-tests. Statistical significance was tested at P < .05. Table 2 shows descriptive statistics for the measurements before and after treatment, and the results of paired samples t-tests. Microsoft Office / Excel 2016 (Microsoft, Redmond, Wash) was used for statistical analysis.

3. RESULTS

The intraoperator error was limited (average correlation results: r=0.98). As an example, Fig. (4) shows all the repeated measurements of the variable SN. MP is between the upper and lower limit of agreement, which validates the tracing method. The null hypothesis was rejected for three vertical parameters and one sagittal parameter. Descriptive statistics and treatment changes for the cephalometric variables derived before and after orthodontic treatment are shown in Table 2

Fig. (4)
Bland - altman plot, all the repeated measurements are between the ULA and LLA.


Table 2
Descriptive statistics and Treatment Changes.


3.1. Vertical Assessment

SN-MP angle increased significantly from T1 to T2 (0.66 degree, p < 0,05), and Maxillomandibular Angle (MMA) increased a mean of 0.9 degree (p < 0,05). These increases had no statistical effect (p > 0,05) on the ratio of lower anterior facial height to the total anterior facial height (LAFH/TAFH). S.AR/AR.GO increased significantly (3.77%, p < 0,05).

3.2. Sagittal Assessment

SNB and S.N.POG changes were not statistically significant (p > 0,05). N.A.POG showed a mean increase of 1.16 degrees (p < 0,05).

4. DISCUSSION

The aim of the present study was to investigate the mandibular changes in the sagittal and vertical planes after RME as the only treatment intervention. RME was performed using the bonded acrylic splint expander.

One of the limitations of this study was the absence of a control group. The maxillary transverse deficiency is not a self-corrected malocclusion. It is not ethical to leave patients with maxillary deficiency without intervention. Pandis also considered the use of historical control groups problematic [32Pandis N. Use of controls in clinical trials. Am J Orthod Dentofacial Orthop 2012; 141(2): 250-1.
[http://dx.doi.org/10.1016/j.ajodo.2011.10.018] [PMID: 22284295]
]. Another limitation was the unbalanced population (16 males versus 12 females), caused by the additional criterion used in the present study (the absence of necessity for mandibular intervention). This criterion decreased the number of patients available for the present study. It was challenging to find patients who need only maxillary orthodontic intervention during the first six months of the treatment period. However, the unbalanced population would not affect the biomechanical behavior of the mandible after maxillary expansion because it is not fully controlled by hormones. For the same reason, it was unfeasible to divide the patients into groups according to each type of malocclusion, or to increase the sample size.

Schudy emphasized that increasing the VD may exacerbate the sagittal discrepancy [33Schudy FF. Vertical growth versus anteroposterior growth as related to function and treatment. Angle Orthod 1964; 34(2): 75-93.]. Almost every orthodontic malrelationship has a vertical, sagittal and transverse component [21Chang JY, McNamara JA Jr, Herberger TA. A longitudinal study of skeletal side effects induced by rapid maxillary expansion. Am J Orthod Dentofacial Orthop 1997; 112(3): 330-7.
[http://dx.doi.org/10.1016/S0889-5406(97)70264-6] [PMID: 9294364]
]. The present study results showed a mandibular clockwise rotation and a bite opening effect after RME. As MMA increased significantly (p < 0,05), it could be concluded that the clockwise rotation resulted from the dentoalveolar changes rather than the maxillary vertical displacement, which might affect the ratio of LAFH/TAFH. The LAFH/TAFH showed no significant changes after RME (p > 0,05). The dentoalveolar changes could be like a flexion of the alveolar ridges [34Brunetto M, Andriani JdaS, Ribeiro GL, Locks A, Correa M, Correa LR. Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: A clinical trial study. Am J Orthod Dentofacial Orthop 2013; 143(5): 633-44.
[http://dx.doi.org/10.1016/j.ajodo.2012.12.008] [PMID: 23631965]
], in addition to the tipping and extrusion of the anchor teeth [35Handelman CS, Wang L, BeGole EA, Haas AJ. Nonsurgical rapid maxillary expansion in adults: Report on 47 cases using the Haas expander. Angle Orthod 2000; 70(2): 129-44.
[PMID: 10833001]
, 36Garib DG, Henriques JF, Carvalho PE, Gomes SC. Longitudinal effects of rapid maxillary expansion. Angle Orthod 2007; 77(3): 442-8.
[http://dx.doi.org/10.2319/0003-3219(2007)077[0442:LEORME]2.0.CO;2] [PMID: 17465651]
]. These changes could be compensated in the next stage if the patient had to go through a fixed appliance phase of treatment. This could be accomplished through the modification of the maxillary posterior teeth torque. However, the present study results were favorable because if the maxillary vertical displacement was responsible for the clockwise rotation, it should be controlled through extraoral appliances (like vertical pull chin cap), as suggested earlier [37Majourau A, Nanda R. Biomechanical basis of vertical dimension control during rapid palatal expansion therapy. Am J Orthod Dentofacial Orthop 1994; 106(3): 322-8.
[http://dx.doi.org/10.1016/S0889-5406(94)70053-2] [PMID: 8074098]
]. Furthermore, this could be the reason for controversy between short term and long term clinical studies. The short term studies recorded VD increases after RME [24Davis WM, Kronman JH. Anatomical changes induced by splitting of the midpalatal suture. Angle Orthod 1969; 39(2): 126-32.
[PMID: 5252050]
]. The long term studies suggested that the VD increase was transient and had no long term deleterious effect [23Lineberger MW, McNamara JA Jr, Baccetti T, Herberger T, Franchi L. Effects of rapid maxillary expansion in hyperdivergent patients. Am J Orthod Dentofacial Orthop 2012; 142(1): 60-9.
[http://dx.doi.org/10.1016/j.ajodo.2012.02.019] [PMID: 22748991]
]. The long term study, because of duration, would include a second phase of fixed appliances therapy with many variables to control; like the torque and prescription of posterior teeth brackets. The short term study may include a phase of fixed appliances therapy and may not.

The significant increase in S.AR/AR.GO (p < 0,05) was caused either by S.AR increase or by AR.GO decrease. AR.GO decrease could be a result of condylar repositioning into a more upper or centric position. This may be produced by the elimination of the deviating contacts after expansion. The increase in S.AR could be induced if the expansion affected the spheno-occipital synchondrosis as suggested by some authors [38Davis WM, Kronman JH. Anatomical changes induced by splitting of the midpalatal suture. Angle Orthod 1969; 39(2): 126-32.
[PMID: 5252050]
]. However, the lateral cephalometric radiographs are insufficient to evaluate the RME effect on the mandibular condyle position in its fossa. Further investigations are needed using other methods like Magnetic Resonance Imaging (MRI) and Cone Beam Computed Tomography (CBCT).

There was no mandibular displacement in the sagittal plane. However, there was a clockwise rotation which could camouflage any forward repositioning. The angle of convexity increased a mean of 1.16 degree (p < 0,05), which could be resulted from the mandible clockwise rotation or the advancement of point A. Haas reported a forward displacement of point A after RME [6Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthod 1961; 31(2): 73-90.]. However, this convexity increase (1.16 degrees) in the growing patients could be compensated by the continuous growth of the mandible. Pancherz reported a late skeletal growth after the age of twenty [39Pancherz H, Bjerklin K, Hashemi K. Late adult skeletofacial growth after adolescent Herbst therapy: A 32-year longitudinal follow-up study. Am J Orthod Dentofacial Orthop 2015; 147(1): 19-28.
[http://dx.doi.org/10.1016/j.ajodo.2014.06.011] [PMID: 25533068]
].

CONCLUSION

Within the limitation of this study, the results indicate:

  • There was a clockwise rotation of the mandible and a bite opening effect after rapid maxillary expansion.
  • The skeletal convexity increased after RME.
  • Mandibular clockwise rotation and increased skeletal convexity are not contraindications for rapid maxillary expansion.
  • RME may affect the condyle position and the posterior cranial base.

LIST OF ABBREVIATIONS

RME  = Rapid Maxillary Expansion
VD  = Vertical Dimension
MRI  = Magnetic Resonance Imaging
CBCT  = Cone Beam Computed Tomography
DICOM  = Digital Imaging and Communications in Medicine
WMA  = World Medical Association

ETHICAL APPROVAL AND CONSENT TO PARTICIPATE

The Study Was Approved by The Institutional Review Board of Tishreen University, Syrian Arab Republic Under Approval No.1143.

HUMAN AND ANIMAL RIGHTS

Not applicable.

CONSENT FOR PUBLICATION

Informed consents were performed.

AVAILABILITY OF DATA AND MATERIALS

The data supporting the findings of the article is available in the Department of Orthodontics, Faculty of Dentistry, Tishreen University, Lattakia, Syrian Arab Republic [www.tishreen.edu.sy].

FUNDING

None.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

The authors acknowledge Dr. Hasan Ali (MSc. in Pediatric Dentistry) for the aid in study design, and Dr. Majed Amran (MSc. in Endodontics) for the aid in manuscript revision.

REFERENCES

[1] McNamara JA Jr, Franchi L, McClatchey LM. Orthodontic and orthopedic expansion of the transverse dimension: A four decade perspective. Semin Orthod 2019; 25: 3-15.
[http://dx.doi.org/10.1053/j.sodo.2019.02.002]
[2] McNamara JA Jr, Lione R, Franchi L, et al. The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod 2015; 16: 33.
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[3] Moawad SG, Bouserhal J, Al-Munajed MK. Assessment of the efficiency of Erbium-YAG laser as an assistant method to rapid maxillary expansion: An in vivo study. Int Orthod 2016; 14(4): 462-75.
[http://dx.doi.org/10.1016/j.ortho.2016.10.015] [PMID: 27856377]
[4] Angell EC. Treatment of irregularities of the permanent adult teeth. Dental Cosmos 1860; 1: 540-4.
[5] Haas AJ. The treatment of maxillary deficiency by opening the midpalatal suture. Angle Orthod 1965; 35(3): 200-17.
[PMID: 14331020]
[6] Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthod 1961; 31(2): 73-90.
[7] Maspero C, Galbiati G, Giannini L, Farronato G. Sagittal and vertical effects of transverse sagittal maxillary expander (TSME) in three different malocclusion groups. Prog Orthod 2015; 16(25): 6.
[http://dx.doi.org/10.1186/s40510-015-0075-z] [PMID: 25907431]
[8] Çörekçi B, Göyenç YB. Dentofacial changes from fan-type rapid maxillary expansion vs traditional rapid maxillary expansion in early mixed dentition. Angle Orthod 2013; 83(5): 842-50.
[http://dx.doi.org/10.2319/103112-837.1] [PMID: 23387338]
[9] Wichelhaus A, Geserick M, Ball J. A new nickel titanium rapid maxillary expansion screw. J Clin Orthod 2004; 38(12): 677-80.
[PMID: 15665443]
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