• The korean journal of orthodontics
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• v.53 no.5
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• pp.289-297
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• 2023

Objective: To analyze the microimplant (MI) displacement pattern on treatment with a maxillary skeletal expander (MSE) using cone-beam computed tomography (CBCT). Methods: Thirty-nine participants (12 males and 27 females; mean age, 18.2 ± 4.2 years) were treated successfully with the MSE II appliance. Their pre- and post-expansion CBCT data were superimposed. The pre- and post-expansion anterior and posterior inter-MI angles, neck and apical inter-MI distance, plate angle, palatal bone thickness at the MI positions, and suture opening at the MI positions were measured and compared. Results: The jackscrew plate was slightly bent in both anterior and posterior areas. There was no significant difference in the extent of suture opening between the anterior and posterior MIs (P > 0.05). The posterior MI to hemiplate line was greater than that anteriorly (P < 0.05). The apical distance between the posterior MIs was greater than that anteriorly (P < 0.05). The palatal thickness at the anterior MIs was significantly greater than that posteriorly (P > 0.01). Conclusions: In the coronal plane, the angulation between the anterior MIs in relation to the jackscrew plate was greater than that between the posterior MIs owing to the differential palatal bone thickness.

• The korean journal of orthodontics
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• v.54 no.1
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• pp.59-68
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• 2024

Objective: To investigate the long-term effects of maxillary skeletal expander (MSE) treatment on functional breathing. Methods: Objective measures of breathing, the peak nasal inspiratory flow (PNIF), and peak oral inspiratory flow (POIF), and subjective measures of breathing, the visual analog scale (VAS) and nasal obstruction symptom evaluation (NOSE) survey, were used to investigate the long-term effects of MSE in functional breathing. Seventeen patients, mean age 19.4 ± 3.9 years treated at the UCLA Orthodontics Clinic were assessed on their functional breathing at 3 timepoints: pre-expansion (T0), post-expansion (T1), and post-orthodontic treatment (T2). Results: Immediately after expansion (T1), all the objective functional breathing values were significantly increased in comparison to T0 (P < 0.05). The VAS total, VAS right and VAS left were significantly lower at T1 in comparison to T0 (P < 0.05). At 26.8 ± 3.9 months after MSE expansion (T2), PNIF total, PNIF right, PNIF left, and POIF were significantly higher when compared to T0 (P < 0.05). Also, VAS total, VAS right and VAS left were significantly lower at T2 when compared to T0 (P < 0.05). Additionally, there was a positive correlation between PNIF and the magnitude of expansion at anterior nasal spine and zygomaticomaxillary point (ZMA). There was a positive correlation between total VAS and the magnitude of expansion at the ZMA. There were no significant changes for the NOSE subjective breathing measurement at all time comparisons. Conclusions: Overall, MSE treatment produces an increased objective and subjective airway improvement that continues to remain stable in the long-term post expansion.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.2
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• pp.126-135
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• 2015

The purpose of this study was to evaluate the skeletal and dentoalveolar effects of facemask therapy and to compare the anchorage of a bonded expander in patients with Class III malocclusion and different vertical skeletal patterns. Twenty subjects with Class III malocclusion were included in this study and were treated with a facemask and bonded expander. Based on the FMA, subjects were divided into two groups of 10 patients each: a high vertical group (HV; mean FMA $33.56^{\circ}$) and an average vertical group (AV; mean FMA $24.88^{\circ}$). Lateral cephalograms were taken and evaluated before and after treatment. In both groups, forward movement of the maxilla and backward rotation of the mandible were observed after treatment, with no statistical differences between the groups. Vertical skeletal variables increased in both groups, but the increase of FMA was significantly larger in the HV group than the AV group. Mesial movement of maxillary molars and proclination of maxillary incisors which indicate anchorage loss of bonded expander were observed in both groups, with no significant differences between the groups. In conclusion, facemask therapy resulted in effective maxillary protraction in both HV and AV groups. However, the open bite tendency was increased more in the HV group.

• The korean journal of orthodontics
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• v.52 no.5
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• pp.372-382
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• 2022

Anterior open bite and transverse discrepancy are often accompanied by hyperdivergent skeletal patterns. In addition, degenerative joint disorders and vertical maxillary excess contribute to an unfavorable convex facial profile with a retruded chin. Correction of this complex three-dimensional problem with orthodontic treatment alone is considered challenging owing to anatomical limitations. Moreover, a history of orthodontic treatment with premolar extraction makes retreatment difficult. This case report illustrates the application of a maxillary tissue bone-borne expander and biocreative reverse curve system in a 23-year-old female patient with a severe anterior open bite and transverse discrepancy who underwent orthodontic treatment with four premolar extractions. By setting the treatment target under precise diagnosis and using appropriate appliances, a satisfactory treatment result could be achieved without orthognathic surgery.

• The korean journal of orthodontics
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• v.51 no.3
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• pp.145-156
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• 2021

Objective: The aim of this retrospective study was to assess the midfacial soft tissue changes following maxillary expansion using micro-implant-supported maxillary skeletal expanders (MSEs) in young adults by cone-beam computerized tomography (CBCT) and to evaluate the correlations between hard and soft tissue changes after MSE usage. Methods: Twenty patients (mean age, 22.4 years; range, 17.6-27.1) with maxillary transverse deficiency treated with MSEs were selected. Mean expansion amount was 6.5 mm. CBCT images taken before and after expansion were superimposed to measure the changes in soft and hard tissue landmarks. Statistical analyses were performed using paired t-test and Pearson's correlation analysis on the basis of the normality of data. Results: Average lateral movement of the cheek points was 1.35 mm (right) and 1.08 mm (left), and that of the alar curvature points was 1.03 mm (right) and 1.02 mm (left). Average forward displacement of the cheek points was 0.59 mm (right) and 0.44 mm (left), and that of the alar curvature points was 0.61 mm (right) and 0.77 mm (left) (p < 0.05). Anterior nasal spine (ANS), posterior nasal spine (PNS), and alveolar bone width showed significant increments (p < 0.05). Changes in the cheek and alar curvature points on both sides significantly correlated with hard tissue changes (p < 0.05). Conclusions: Maxillary expansion using MSEs resulted in significant lateral and forward movements of the soft tissues of cheek and alar curvature points on both sides in young adults and correlated with the maxillary suture opening at the ANS and PNS.

• The korean journal of orthodontics
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• v.52 no.2
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• pp.131-141
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• 2022

Objective: The purpose of this study was to compare the differences in dentoskeletal and soft tissue changes following conventional tooth-borne rapid maxillary expansion (RME) between adolescents and adults. Methods: Dentoskeletal and soft tissue variables of 17 adolescents and 17 adults were analyzed on posteroanterior and lateral cephalograms and frontal photographs at pretreatment (T1) and after conventional RME using tooth-borne expanders (T2). Changes in variables within each group between T1 and T2 were analyzed using Wilcoxon signed-rank test. Mann-Whitney U test was used to determine the differences in the pretreatment age, expansion and post-expansion durations, and dentoskeletal and soft tissue changes after RME between the groups. Spearman's correlation between pretreatment age and transverse dentoskeletal changes in the adolescent group was calculated. Results: Despite similar amounts of expansion at the crown level in both groups, the adult group underwent less skeletal expansion with less intermolar root expansion after RME than the adolescent group. The skeletal vertical dimension increased significantly in both groups without significant intergroup difference. The anteroposterior position of the maxilla was maintained in both groups, while a greater backward displacement of the mandible was evident in the adult group than that in the adolescent group after RME. The soft tissue alar width increased in both groups without a significant intergroup difference. In the adolescent group, pretreatment age was not significantly correlated with transverse dentoskeletal changes. Conclusions: Conventional RME may induce similar soft tissue changes but different dentoskeletal changes between adolescents and adults.

• Journal of the korean academy of Pediatric Dentistry
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• v.41 no.4
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• pp.298-305
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• 2014

The purpose of this study is to evaluate the effects of facemask therapy in patients with Class III malocclusion with two types of bonded expanders covering different numbers of anchored teeth and to compare the anchorage value of two types of bonded expander. Eighteen subjects with Class III malocclusion in early mixed dentition were included in this study, and subjects were divided into two groups based on the number of teeth covered by bonded expander: group 1 (splinting four teeth on each side, 9 subjects) and group 2 (splinting three teeth on each side, 9 subjects). Lateral cephalograms were obtained and assessed before (T1) and after (T2) the treatment. The facemask therapy showed skeletal effects including anterior movement of maxilla and backward rotation of mandible in both groups, with no significant differences between groups. Mesial movement of maxillary molars which indicates anchorage loss of the bonded expander was found in both groups, but significantly larger mesial movement was found in group 2 than in group 1. In conclusion, the value of anchorage was different according to the number of teeth covered by bonded expander as an intraoral anchorage of facemask, but there were no significant differences in skeletal effects.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.1
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• pp.45-52
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• 2015

The purpose of this study was to compare and evaluate facemask effects when two types of intraoral appliances were used for maxillary protraction for patients with class III malocclusion. Eighteen patients with class III malocclusion were treated with a facemask for an average of 12 months. Two types of intraoral appliances were used: nine patients were treated with bonded expander (Group 1), and nine patients with Hyrax (Group 2). Cephalometric radiographs were taken before and after treatment. Cephalometric radiographs were traced, analyzed, and the results such as sagittal, vertical and soft-tissue changes were compared between two groups. The amount of anchorage loss was also measured to evaluate the difference between two groups. All patients showed significant sagittal skeletal changes after treatment, and there was no statistically significant difference between the two groups. When anchorage loss was evaluated, no differences were shown between the two. Facemask with Hyrax or bonded expander is similarly an effective method as a treatment in class III malocclusion patients.

• The korean journal of orthodontics
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• v.52 no.6
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• pp.399-411
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• 2022

Objective: The objective of this randomized clinical trial was to study the skeletal and dental effects of low-level laser therapy (LLLT) along with a miniscrew-assisted expander (Hyrax) after six months of retention. Methods: After sequence generation, concealed allocation, and implementation, 24 female patients were randomly divided (1:1) into two-groups: bone-borne rapid palatal expansion (BBE) without LLLT (n = 12) and BBE with LLLT (n = 12). Eligibility criteria included female patients aged 10-13 years old with bilateral posterior crossbites. Intraoral and extraoral photographs, cone-beam computed tomography images, and digital study models were obtained before expansion and six months after retention. The 7 mm Hyrax appliance was anchored to four palatal mini-screws, which were activated twice daily for 15 days, then locked and kept in place as a retainer. LLLT was performed in the laser group during expansion and retention, according to the guidelines provided. Results: The records of 24 patients were analyzed. According to the post-retention measurements, both groups showed a significant increase in nasal and maxillary widths and total facial height. In the laser group, the Sella-Nasion-Point A and Point A-Nasion-Point B angles and the interpremolar apical distance were significantly increased. Conclusions: Within the limitations of this study, the results suggest that the parameters and protocol of LLLT do not clinically affect the efficiency of BBE in prepubertal and pubertal patients.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.15 no.1
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• pp.84-88
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• 2019

Malocclusion occurs more frequently in Special Health Care Needed (SHCN) patients than those in general. As caregiver's needs for orthodontic treatment tend to increase, the dentist should know how to decide the extent of treatment. This case report is about orthodontic treatment for two SHCN patients; one patient with cerebral palsy, and another patient with autism. A 10-year-old patient with cerebral palsy showed protrusion and rotation of maxillary anterior teeth. To resolve his chief complaints and make better oral hygiene, he underwent orthodontic treatment using micro tube appliances for 6 months. Another 11-year-old patient with autism had anterior crossbite and showed space deficiency of #13 and chronic gingivitis because of poor oral hygiene. She underwent orthodontic treatment with maxillary skeletal expander, facemask and AP expansion appliance. After 18 months we found positive overjet and ended the treatment. When giving SHCNs orthodontic treatment, the extent of treatment can be chosen according to the patient's cooperative ability and the traits of disabilities. Before initiating orthodontic treatment, the caregivers should be aware of their limitations of the treatment. Since oral hygiene is crucial factor in every dental treatment, education of oral hygiene process for the caregivers and SHCN patient must be done before the orthodontic treatment.