• The korean journal of orthodontics
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• v.50 no.5
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• pp.304-313
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• 2020

Objective: The aim of this study was to evaluate the stability of bimaxillary surgery involving bilateral intraoral vertical ramus osteotomy performed with or without presurgical miniscrew-assisted rapid palatal expansion (MARPE) in adult patients with skeletal Class III malocclusion. Methods: A total of 40 adult patients with skeletal Class III malocclusion were retrospectively divided into two groups (n = 20 each) according to the use of MARPE for the correction of transverse maxillomandibular discrepancy during presurgical orthodontic treatment. Serial lateral cephalograms and dental casts were analyzed until 6 months after surgery. Results: Before presurgical orthodontic treatment, there was no significant differences in terms of sex and age between groups. However, the difference of approximately 3.1 mm in the maxillomandibular intermolar width was statistically significant (p < 0.001). Two days after surgery, the mandible had moved backward and upward without any significant intergroup difference. Six months after surgery, the maxillary intercanine (2.7 ± 2.1 mm), interpremolar (3.6 ± 2.4 mm), and intermolar (2.0 ± 1.3 mm) arch widths were significantly increased (p < 0.001) relative to the values before presurgical orthodontic treatment in the MARPE group; these widths were maintained or decreased in the control group. However, there was no significant difference in surgical changes and the postsurgical stability between the two groups. No significant correlations existed between the amount of maxillary expansion and postsurgical mandibular movement. Conclusions: MARPE is useful for stable and nonsurgical expansion of the maxilla in adult patients with skeletal Class III malocclusion who are scheduled for bimaxillary surgery.

• Journal of Dental Anesthesia and Pain Medicine
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• v.20 no.1
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• pp.45-47
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• 2020

Endotracheal tube damage is a well-known complication of maxillary surgery. We report a case of failure to ventilate due to superficial damage to the tubing between the cuff and pilot balloon in the nasal portion of a north facing Ring, Adair and Elwyn pre-formed endotracheal tube during Surgically Assisted Rapid Palatal Expansion surgery. The endotracheal tube was replaced uneventfully and surgery completed successfully. On reflection, we feel that that the vulnerable position of the cuff-pilot tubing significantly contributed to this critical incident and suggest that increased recognition of this is vital for the prevention of such cases in the future.

• The korean journal of orthodontics
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• v.22 no.3 s.38
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• pp.531-556
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• 1992

The majority of the commonly used protraction headgears for the protraction of small and/or retropositioned maxilla not allow a change in the point of force application or direction of the force delivery to attain predictable results because of the position of the upper and lower lips to avoid discomfort to the patient. The purpose of this study was to investigate the initial reaction of maxillofacial complex according to the change of force variables such as direction and point of force application with designing an antenna type-modified protraction head gear. A macerated human skull with well aligned upper teeth was used to experimental model and the investigation was done by double exposure holographic interferometry. Fringe patterns of each protraction conditions were compared and analized. The results were as follows. (Frontal view) 1. The Counterclockwise rotation of the maxilla was showed by parallel protraction to occlusal plane and the fringe was decreased in number as higher point of force application. 2. Generally, the number of fringe was increased in 500gm of protraction force than in 300gm. 3. When apply the protraction force to the maxilla with rapid palatal expansion, the direction of fringe patterns was differed from the protraction without expansion. 4. In most of cases, the counterclockwise rotation was decreased in case of the direction of the force is $20^{\circ}$ downward to occlusal plane compared to the parallel direction. 5. At the point of force application is 15mm above and the direction of force is 20 downward to occlusal plane , the translation of the maxillary complex was showed. (Lateral view) 6. The direction of fringe patterns of the facial bones were differed each other by the sutures, and showed almost parallel when apply the 300gm and 500gm of protraction force. 7. In case of rapid palatal expansion with protraction of the maxilla, the fringe patterns between the maxillary area and the area from the posterior of the maxillary first molar to the pterygomaxillary fissure were differed. In case without rapid palatal expansion, the changes of direction and point of the force application did not affect to the direction and the number of the fringe patterns.

• 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.

• Journal of the korean academy of Pediatric Dentistry
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• v.46 no.4
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• pp.369-381
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• 2019

The aim of this study was to analyze the changes and improvements in symptoms of sleep-disordered breathing (SDB) using semi-rapid maxillary expansion (SRME) in children with narrow maxilla and SDB symptoms. Subjects were 15 patients with sleep disorder (apnea-hypopnea index, AHI ≥ 1) and narrow maxillary arch between 7 and 9 years of age. Before the SRME was applied, all subjects underwent pediatric sleep questionnaires (PSQ), lateral cephalometry, and portable sleep monitoring before expansion (T0). All subjects were treated with SRME for 2 months, followed by maintenance for the next 3 months. All subjects had undergone PSQ, lateral cephalometry, and portable sleep monitoring after expansion (T1). Adenoidal-nasopharyngeal ratio (ANR), upper airway width and hyoid bone position were measured by lateral cephalometry. The data before and after SRME were statistically analyzed with frequency analysis and Wilcoxon signed rank test. As reported by PSQ, the total PSQ scale was declined significantly from 0.45 (T0) to 0.18 (T1) (p = 0.001). Particularly, snoring, breathing, and inattention hyperactivity were significantly improved (p = 0.001). ANR significantly decreased from 0.63 (T0) to 0.51 (T1) (p = 0.003). After maxillary expansion, only palatopharyngeal airway width was significantly increased (p = 0.035). There was no statistically significant difference in position of hyoid bone after expansion (p = 0.333). From analysis of portable sleep monitoring, changes in sleep characteristics showed a statistically significant decrease in AHI and ODI, and the lowest oxygen desaturation was significantly increased after SRME (p = 0.001, 0.004, 0.023). In conclusion, early diagnosis with questionnaires and portable sleep monitoring is important. Treatment using SRME will improve breathing of children with SDB.

• Journal of the korean academy of Pediatric Dentistry
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• v.25 no.3
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• pp.604-612
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• 1998

The majority of Class III malocclusion have maxillary retrusion. Thus, it becomes obvious that management of most skeletal Class III malocclusion cases should include maxillary protraction as major objective. Additionally, in Class III malocclusion with posterior crossbite, RME "disarticulates" the maxilla and initiates cellular response in the sutures, allowing a more positive reaction to protraction forces. Using facemask with RME helped in correction of skeletal Class III malocclusion by the anterior displacement of maxilla and maxillary dentition, and changing the direction of the growth of mandible. Thus, acceptable improvement in the Class III profile was performed.

• The korean journal of orthodontics
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• v.46 no.5
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• pp.269-279
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• 2016

Objective: Rapid maxillary expansion (RME) is used to expand the maxilla and increase arch perimeter; yet, there are few reports on its effects on the sphenoid bone. With cone-beam computed topography (CBCT), it is possible to visualize sphenoid bone changes. The purpose of this study was to investigate sphenoid bone changes observed in conjunction with RME treatments, using CBCT. Methods: Sixty patients (34 women and 26 men, aged 11-17 years) underwent RME as part of their orthodontic treatment. Patients were randomly assigned to one of three groups: a tooth-anchored group, a bone-anchored group, or a control group. Initial CBCT scans were performed preceding the RME treatment ($T_1$) and again directly after the completion of expansion ($T_2$). Statistical analysis included ANOVA, descriptive statistics, and the intraclass correlation coefficient (ICC). Results: The reliability of the landmark location was at least 0.783, and the largest ICC mean measurement error was 2.32 mm. With regard to distances, the largest change was 0.78 mm, which was not statistically significant (p > 0.05). Statistical significance was established in patient groups of the same sex and treatment type for the following distance measurements: right anterior lateral pterygoid plate to the right edge of the hypophyseal fossa ($d_2$), anterior distance between the medial pterygoid plates ($d_4$), and anterior distance between the left medial and lateral plates ($d_8$). Conclusions: In this study, there were no clinically significant changes in the sphenoid bone due to RME treatments regardless of sex or treatment type.

• The korean journal of orthodontics
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• v.12 no.2
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• pp.109-117
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• 1982

The author has observed the gross reactions of surrounding maxillary sutures to the widening of midpalatal suture in comparison of young dog with adult dog. Experimental animals used was two young dog and two adult dog with normal palate. After midpalatal suture was seperated with rapid palatal expansion device, experimental animals were sacrificed to observe the surrounding maxillary sutures. The following results were obtained. 1. In adult dog, nasoincisive suture was not expanded, while in young dog it was expanded. 2. In adult dog, pterygopalatine suture was hardly expanded, while in young dog it was expanded definitely. 3. In adult dog, frontomaxillary suture was not expanded, while in young dog it was expanded unilaterally. 4. In adult dog, palatoethmoidal suture was not expanded, while in young dog it was expanded unilateraily.

• The korean journal of orthodontics
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• v.22 no.3 s.38
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• pp.509-529
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• 1992

Skeletal Class III malocclusion is one of the most difficult type to treat and stabilize. For a child with developing skeletal Class III malocclusion, the treatment objective would be to stimulate maxillary growth, particulary one who has markedly deficient maxilla, and to restrain excessive mandibular growth. In order to stimulate the maxillary growth, maxillary protraction appliance is the one of the effective orthopedic appliances in skeletal Class III. The purposes of this study were as follows ; evaluation of the skeletal and dental changes of the maxillary protraction in children with Class III Maxillary deficiency , comparison of the clinical effects between the group with RPE and labiolingual intraoral appliances , comparison of the clinical effects and stability related to the ages of the patients : stability of the maxillary protraction about 1 year after retention. The subjects consisted of 60 children between the ages of 8 and 13.4 who were diagnosed as Class III with maxillary deficiency and were treated with Face Mask (Delaire Type) from the Dept. of Orthodontics Yong Dong Severance Hospital, Yonsei University. 48 children wore the RPE and 12 children wore Labiolingual Appliance. Lateral Cephalograms were taken for each patient at before and after correction of anterior cross-bite in 60 children, and after an observation period of 10 to 14 months in 19 children. X and Y coordinate of 10 landmarks were analyzed using a horizontal line through sella and rotated $6^{\circ}$ down anteriorly as the horizontal reference axis, and a perpendicular verticual line through sella as the vertical reference axis. Each of the 31 measurents (10 verticals, 10 horizontals, 2 angles and 9 others) was statistically analyzed using SPSS/PC statistics. The results are as follows; 1. After maxillary protraction the maxilla and maxillary teeth moved downward and forward, while the mandible and mandibular incisor rotated downward and backward. 2. Maxillary protraction with rapid palatal expansion appliance was more effective than with labiolingual appliance. 3. More downward movement of the posterior palatal plane obserbed with maxillary protraction doing the midpalatal suture opening than with protraction after finishing the palatal expansion 4. The clinical effects of protraction and changes of the retention periods were not statistically significant among the age groups. 5. During the retention period, maxilla and maxillary teeth, and mandible and mandibular teeth moved downward and forward, however the mandibular changes were larger than the maxillary changes.

• Journal of the korean academy of Pediatric Dentistry
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• v.49 no.4
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• pp.402-413
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• 2022

The aim of this study was to identify factors that affect the treatment duration and to predict the duration of forced eruption in impacted maxillary canines using panoramic radiographs and cone-beam computed tomography. This retrospective study was performed by reviewing medical records and radiographs of 73 patients (93 impacted maxillary canines) from the age of 8 to 18 years who were treated with surgical and orthodontic interventions on impacted maxillary canines from January 2012 to December 2020 in Ajou University Dental Hospital. Stepwise multiple regression analysis showed that the distance between the canine cusp tip and the occlusal plane, mesio-distal location, bucco-palatal location, patient's age, and use of rapid palatal expansion are significant factors with regard to the duration of forced eruption. There was a statistically significant correlation of the treatment duration with the angulation between the axis of the canine and the occlusal plane and unilateral or bilateral impaction. It can be concluded that the duration of forced eruption in impacted maxillary canines could be shorter when the impacted canine is closer to the occlusal plane and located in the lateral incisor or canine area, buccal or middle, the patient is younger and uses rapid palatal expansion.