Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
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Three Dimensional Skeletal, Dentoalveolar and Airway Space Changes after Slow Maxillary Expansion in Children

어린이에서 저속 상악 확장에 따른 골격성, 치아치조성, 기도 변화에 대한 3차원적 평가

  • Nawoon Kim (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Daewoo Lee (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Jae-Gon Kim (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University) ;
  • Yeonmi Yang (Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Jeonbuk National University)
  • 김나운 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소) ;
  • 이대우 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소) ;
  • 김재곤 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소) ;
  • 양연미 (전북대학교 치과대학 소아치과학교실 및 구강생체과학연구소)
  • Received : 2023.02.08
  • Accepted : 2023.03.13
  • Published : 2023.05.31
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Abstract

The aim of this study was to investigate the effects of slow maxillary expansion (SME) on the dentoalveolar, skeletal, upper airway, and maxillary sinus using cone-beam computed tomography (CBCT). Twenty-three orthodontic patients (mean age 8.93 ± 1.61 years) who were treated with maxillary expansion using banded hyrax in the Department of Pediatric Dentistry at Jeonbuk National University Dental Hospital were included. According to the expansion speed applied, they were divided into two groups: SME (12 subjects, mean age 8.92 ± 1.45 years) and rapid maxillary expansion (RME, 11 subjects, mean age 8.94 ± 1.84 years). CBCT were obtained before (T0) and after (T1) the treatment and were analyzed with InVivo5 software (Anatomage, San Jose, CA, USA). Descriptive statistics showed no significant differences between the two groups in age, sex, or skeletal maturity. There were significant increases in maxillary width at the dentoalveolar and skeletal levels for both groups. Upper airway volume revealed a significant increase of 38.59% in the SME group and 28.72% in the RME group. However, there was no significant difference between SME group and RME group in all measurements. This study suggested the efficacy of SME in growing patients. SME was effective in increasing not only dentoalveolar and skeletal measurements but also airway volume. Therefore, pediatric dentists should select an appropriate expansion method considering the physiological aspects of periodontal tissues and discomfort in growing children.

이 연구의 목적은 상악 확장 속도에 따른 치아치조성, 골격성 효과 및 상기도에 대한 효과를 CBCT를 통해 3차원적으로 분석하여 저속 상악 확장의 효과를 확인하는 것이다. 전북대학교 소아치과에서 Banded hyrax를 이용하여 상악 확장을 시행한 23명(평균 8.93 ± 1.61세)의 환자가 포함되었다. 확장 속도에 따라 저속 상악 확장군과 급속 상악 확장군으로 분류되었다. 치료 전후의 치아치조성, 골격성, 기도 부피 변화를 평가하기 위해 치료전(T0)과 치료 종료 및 유지 후(T1)에 촬영한 CBCT를 사용하였다. 상악 확장 결과 두 군 모두에서 치아치조성, 골격성 측정 값 및 상기도 부피의 유의한 증가가 관찰되었다. 또한 모든 측정 값에서 저속 상악 확장과 급속 상악 확장 간의 유의한 차이를 보이지 않았다. 이 연구는 혼합치열기 어린이에서 저속 상악 확장의 효과에 대해 확인하였다. 저속 상악 확장은 치아치조성, 골격성 측정 값 뿐만 아니라 기도 부피, 상악동 기체 부피에서도 유의한 효과를 보였다. 또한, 급속 상악 확장의 효과와 비교하였을 때 유의한 차이를 보이지 않았다. 따라서 소아치과의사는 성장기 어린이의 치주 조직의 생리적 측면, 불편감에 따른 협조도 등을 고려하여 급속 상악 확장과 저속 상악 확장 중 적절한 방법을 선택할 수 있을 것이다.

Keywords

Acknowledgement

This paper was supported by Fund of Biomedical Research Institute, Jeonbuk National University Hospital.

References

  1. Son BH, Hwang CJ, Kim GH, Lee GJ : Craniofacial growth and development, 1st ed. DaehanNarae, Seoul, 52-105, 2007.
  2. Linder-Aronson S : Adenoids. Their effects on mode of breathing and nasal airflow and their relationships to characteristics of the facial skeleton and the dentition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol Suppl, 265:1-132, 1970.
  3. Behlfelt K, Linder-Aronson S, McWilliam J, Neander P, Laage-Hellman J : Dentition in children with enlarged tonsils compared to control children. Eur J Orthod, 11:416-429, 1989. https://doi.org/10.1093/oxfordjournals.ejo.a036014
  4. Proffit WR, Fields HW, Larson BE, Sarver DM : Contemporary orthodontics, 6th ed. Elsevier, Amsterdam, 454-464, 2021.
  5. McNamara JA Jr : Early intervention in the transverse dimension: is it worth the effort? Am J Orthod Dentofacial Orthop, 121:572-574, 2002. https://doi.org/10.1067/mod.2002.124167
  6. Troelstrup B, Moller E : Electromyography of the temporalis and masseter muscles in children with unilateral cross-bite. Scand J Dent Res, 78:425-430, 1970. https://doi.org/10.1111/j.1600-0722.1970.tb02092.x
  7. Neiva PD, Kirkwood RN, Mendes PL, Zabjek K, Becker HG, Mathur S : Postural disorders in mouth breathing children : a systematic review. Braz J Phys Ther, 22:7-19, 2018. https://doi.org/10.1016/j.bjpt.2017.06.011
  8. Kutin G, Hawes RR : Posterior cross-bites in the deciduous and mixed dentitions. Am J Orthod, 56:491-504, 1969. https://doi.org/10.1016/0002-9416(69)90210-3
  9. Petren S, Bondemark L, Soderfeldt B : A systematic review concerning early orthodontic treatment of unilateral posterior crossbite. Angle Orthod, 73:588-596, 2003.
  10. Garrett BJ, Caruso JM, Rungcharassaeng K, Farrage JR, Kim JS, Taylor GD : Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop, 134:8-9, 2008. https://doi.org/10.1016/j.ajodo.2008.06.004
  11. Pereira JDS, Jacob HB, Locks A, Brunetto M, Ribeiro GLU : Evaluation of the rapid and slow maxillary expansion using cone-beam computed tomography: a randomized clinical trial. Dental Press J Orthod, 22:61-68, 2017. https://doi.org/10.1590/2177-6709.22.2.061-068.oar
  12. Podesser B, Williams S, Crismani AG, Bantleon HP : Evaluation of the effects of rapid maxillary expansion in growing children using computer tomography scanning: a pilot study. Eur J Orthod, 29:37-44, 2007. https://doi.org/10.1093/ejo/cjl068
  13. Lione R, Ballanti F, Franchi L, Baccetti T, Cozza P : Treatment and posttreatment skeletal effects of rapid maxillary expansion studied with low-dose computed tomography in growing subjects. Am J Orthod Dentofacial Orthop, 134:389-392, 2008. https://doi.org/10.1016/j.ajodo.2008.05.011
  14. Mosleh MI, Kaddah MA, Abd ElSayed FA, ElSayed HS : Comparison of transverse changes during maxillary expansion with 4-point bone-borne and tooth-borne maxillary expanders. Am J Orthod Dentofacial Orthop, 148:599-607, 2015. https://doi.org/10.1016/j.ajodo.2015.04.040
  15. Ramires T, Maia RA, Barone JR : Nasal cavity changes and the respiratory standard after maxillary expansion. Braz J Otorhinolaryngol, 74:763-769, 2008. https://doi.org/10.1016/S1808-8694(15)31388-4
  16. Iwasaki T, Sato H, Suga H, Minami A, Yamamoto Y, Takemoto Y, Inada E, Saitoh I, Kakuno E, Kanomi R, Yamasaki Y : Herbst appliance effects on pharyngeal airway ventilation evaluated using computational fluid dynamics. Angle Orthod, 87:397-403, 2017. https://doi.org/10.2319/080616-603.1
  17. Iwasaki T, Yanagisawa-Minami A, Suga H, Shirazawa Y, Tsujii T, Yamamoto Y, Ban Y, Sato-Hashiguchi M, Sato H, Kanomi R, Yamasaki Y : Rapid maxillary expansion effects of nasal airway in children with cleft lip and palate using computational fluid dynamics. Orthod Craniofac Res, 22:201-207, 2019. https://doi.org/10.1111/ocr.12311
  18. Iwasaki T, Suga H, Minami-Yanagisawa A, Hashiguchi-Sato M, Sato H, Yamamoto Y, Shirazawa Y, Tsujii T, Kanomi R, Yamasaki Y : Upper airway in children with unilateral cleft lip and palate evaluated with computational fluid dynamics. Am J Orthod Dentofacial Orthop, 156:257-265, 2019. https://doi.org/10.1016/j.ajodo.2018.09.013
  19. McNamara JA Jr, Lione R, Franchi L, Angelieri F, Cevidanes LH, Darendeliler MA, Cozza P : The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod, 16:33, 2015.
  20. Altieri F, Cassetta M : Comparison of changes in skeletal, dentoalveolar, periodontal, and nasal structures after tooth-borne or bone-borne rapid maxillary expansion: A parallel cohort study. Am J Orthod Dentofacial Orthop, 161:E336-E344, 2022. https://doi.org/10.1016/j.ajodo.2021.11.007
  21. Krusi M, Eliades T, Papageorgiou SN : Are there benefits from using bone-borne maxillary expansion instead of tooth-borne maxillary expansion? A systematic review with meta-analysis. Prog Orthod, 20:9, 2019.
  22. Giudice AL, Spinuzza P, Rustico L, Messina G, Nucera R : Short-term treatment effects produced by rapid maxillary expansion evaluated with computed tomography: A systematic review with meta-analysis. Korean J Orthod, 50:314-323, 2020. https://doi.org/10.4041/kjod.2020.50.5.314
  23. Luiz Ulema Ribeiro G, Jacob HB, Brunetto M, da Silva Pereira J, Motohiro Tanaka O, Buschang PH : A preliminary 3-D comparison of rapid and slow maxillary expansion in children: A randomized clinical trial. Int J Paediatr Dent, 30:349-359, 2020. https://doi.org/10.1111/ipd.12597
  24. Timms DJ : The dawn of rapid maxillary expansion. Angle Orthod, 69:247-250, 1999.
  25. Caprioglio A, Meneghel M, Fastuca R, Zecca PA, Nucera R, Nosetti L : Rapid maxillary expansion in growing patients: Correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol, 78:23-27, 2014. https://doi.org/10.1016/j.ijporl.2013.10.011
  26. Fastuca R, Meneghel M, Zecca PA, Mangano F, Antonello M, Nucera R, Caprioglio A : Multimodal airway evaluation in growing patients after rapid maxillary expansion. Eur J Paediatr Dent, 16:129-134, 2015.
  27. Machado AJ Jr, Crespo AN, Pauna HF : Rapid maxillary expansion in pediatric patients with obstructive sleep apnea: current and future perspectives. Sleep Med, 51:7-8, 2018. https://doi.org/10.1016/j.sleep.2018.06.002
  28. Lo Giudice A, Fastuca R, Portelli M, Militi A, Bellocchio M, Spinuzza P, Briguglio F, Caprioglio A, Nucera R : Effects of rapid vs slow maxillary expansion on nasal cavity dimensions in growing subjects: a methodological and reproducibility study. Eur J Paediatr Dent, 18:299-304, 2017.
  29. Lanteri V, Farronato M, Ugolini A, Cossellu G, Gaffuri F, Parisi FMR, Cavagnetto D, Abate A, Maspero C : Volumetric Changes in the Upper Airways after Rapid and Slow Maxillary Expansion in Growing Patients: A Case-Control Study. Materials, 13:2239, 2020.
  30. Zhou Y, Long H, Ye N, Xue J, Yang X, Liao L, Lai W : The effectiveness of non-surgical maxillary expansion: a meta-analysis. Eur J Orthod, 36:233-242, 2014. https://doi.org/10.1093/ejo/cjt044
  31. Ghoneima A, AlBarakati S, Jiang F, Kula K, Wasfy T : Computational fluid dynamics analysis of the upper airway after rapid maxillary expansion: a case report. Prog Orthod, 16:10, 2015.
  32. Li J, Shi L, Zhang X, Weng L, Chen H, Lin J : Evaluating the effect of midpalatal corticotomy-assisted rapid maxillary expansion on the upper airway in young adults using computational fluid dynamics. J Zhejiang Univ Sci B, 22:146-155, 2021. https://doi.org/10.1631/jzus.B2000090
  33. Angelieri F, Cevidanes LH, Franchi L, Goncalves JR, Benavides E, McNamara JA JR : Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop, 144:759-769, 2013. https://doi.org/10.1016/j.ajodo.2013.04.022
  34. Persson M, Thilander B : Palatal suture closure in man from 15 to 35 years of age. Am J Orthod, 72:42-52, 1977. https://doi.org/10.1016/0002-9416(77)90123-3
  35. Mah J : The evolution of digital study models. J Clin Orthod, 41:557-561, 2007.
  36. Major MP, Flores-Mir C, Major PW : Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review. Am J Orthod Dentofacial Orthop, 130:700-708, 2006. https://doi.org/10.1016/j.ajodo.2005.05.050
  37. Needleman HL, Hoang CD, Allred E, Hertzberg J, Berde C : Reports of pain by children undergoing rapid palatal expansion. Pediatr Dent, 22:221-226, 2000.
  38. Gecgelen M, Aksoy A, Kirdemir P, Doguc DK, Cesur G, Koskan O, Ozorak O : Evaluation of stress and pain during rapid maxillary expansion treatments. J Oral Rehabil, 39:767-775, 2012. https://doi.org/10.1111/j.1365-2842.2012.02330.x
  39. Adkins MD, Nanda RS, Currier GF : Arch perimeter changes on rapid palatal expansion. Am J Orthod Dentofacial Orthop, 97:194-199, 1990. https://doi.org/10.1016/S0889-5406(05)80051-4
  40. Isaacson RJ, Ingram AH : Forces produced by rapid maxillary expansion. II. Forces present during treatment. Angle Orthod, 34:261-270, 1964.
  41. Garib DG, Henriques JF, Janson G, de Freitas MR, Fernandes AY : Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: a computed tomography evaluation. Am J Orthod Dentofacial Orthop, 129:749-758, 2006. https://doi.org/10.1016/j.ajodo.2006.02.021
  42. Greenbaum KR, Zachrisson BU : The effect of palatal expansion therapy on the periodontal supporting tissues. Am J Orthod, 81:12-21, 1982. https://doi.org/10.1016/0002-9416(82)90283-4
  43. Godoy F, Godoy-Bezerra J, Rosenblatt A : Treatment of posterior crossbite comparing 2 appliances: a community-based trial. Am J Orthod Dentofacial Orthop, 139:E45-E52, 2011. https://doi.org/10.1016/j.ajodo.2010.06.017
  44. Petren S, Bjerklin K, Bondemark L : Stability of unilateral posterior crossbite correction in the mixed dentition: a randomized clinical trial with a 3-years follow-up. Am J Orthod Dentofacial Orthop, 139:E73-E81, 2011. https://doi.org/10.1016/j.ajodo.2010.06.018
  45. Cozzani M, Guiducci A, Mirenghi S, Mutinelli S, Siciliani G : Arch width changes with a rapid maxillary expansion appliance anchored to the primary teeth. Angle Orthod, 77:296-302, 2007. https://doi.org/10.2319/0003-3219(2007)077[0296:AWCWAR]2.0.CO;2