• The Journal of the Korean dental association
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• v.51 no.6
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• pp.322-329
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• 2013

Among the occlusal discrepancies, maxillary transverse deficiency is quite common in several reasons. The reasons are comprised of maxillary hypoplasia, thumb sucking habits, non-syndromic palatal synostosis and syndromal patients including cleft patients. Orthodontic treatment is used routinely to correct a deficiency in young patients while it has limitations for a skeletally mature patient. Surgical treatments help provide effective maxillary expansion to correct a deficiency in adults. Surgical methods can be categorized to segmental Le Fort I osteotomy and surgically assisted rapid maxillary expansion(SARME). Both methods seem successful but each method would have its own indication. We give a review on transverse maxillary deficiency and two surgical methods.

• The korean journal of orthodontics
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• v.50 no.5
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• pp.314-323
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• 2020

Objective: To identify the available evidence on the effects of rapid maxillary expansion (RME) with three-dimensional imaging and provide meta-analytic data from studies assessing the outcomes using computed tomography. Methods: Eleven electronic databases were searched, and prospective case series were selected. Two authors screened all titles and abstracts and assessed full texts of the remaining articles. Seventeen case series were included in the quantitative synthesis. Seven outcomes were investigated: nasal cavity width, maxillary basal bone width, alveolar buccal crest width, alveolar palatal crest width, inter-molar crown width, inter-molar root apex width, and buccopalatal molar inclination. The outcomes were investigated at two-time points: post-expansion (2-6 weeks) and post-retention (4-8 months). Mean differences and 95% confidence intervals were used to summarize and combine the data. Results: All the investigated outcomes showed significant differences post-expansion (maxillary basal bone width, +2.46 mm; nasal cavity width, +1.95 mm; alveolar buccal crest width, +3.90 mm; alveolar palatal crest width, +3.09 mm; intermolar crown width, +5.69 mm; inter-molar root apex width, +2.85 mm; and dental tipping, +3.75°) and post-retention (maxillary basal bone width, +2.21 mm; nasal cavity width, +1.55 mm; alveolar buccal crest width, +3.57 mm; alveolar palatal crest width, +3.32 mm; inter-molar crown width, +5.43 mm; inter-molar root apex width, +4.75 mm; and dental tipping, 2.22°) compared to pre-expansion. Conclusions: After RME, skeletal expansion of the nasomaxillary complex was greater in most caudal structures. Maxillary basal bone showed 10% post-retention relapse. During retention period, uprighting of maxillary molars occurred.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.1
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• pp.60-69
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• 2005

Orthopedic rapid maxillary expansion(RME) has been a common treatment modality used to widen narrow maxillae in young children. However, since more skeletally matured adolescents or adults has closed midpalatal suture, the result of RME was undesirable because of dental tipping with little or no basal skeletal movement and resulted to many other complications. After such treatment, complications often occurred such as alveolar bending, compression of periodontal ligament, extrusion, buccal tipping, and severe relapse. Thus, surgically assisted rapid maxillary expansion(SA-RME) is required, especially for patients over 14 years old, to skeletally release maxillary expansion. We used two methods of maxillary expansion surgery. Surgically assisted rapid maxillary expansion(SA-RME) & surgically assisted posterior segmental expansion(SA-PSE) were used for narrow maxilla. The study was divided into two groups(SA-RME group and SA-PSE group). SA-RME group was consisted of 2 males and 4 females, and the ages of materials ranged from 15 years to 25 years with a mean of 20.2 years. SA-PSE group was consisted of 1 male and 5 females, and the ages ranged from 13 years to 23 years with a mean of 18.7 years. Dental study models were fabricated before starting the expansion and immediately after the expansion was completed. It was fabricated again 1 month later, 3 months later when the expansion device was removed, and 6 months later after the expansion was completed. A repeated measures analysis of variance(ANOVA) test was applied to assess changes between each groups over time. The amount of expansion and the amount of tipping movement each in both groups were compared by using paired t-test and it was also compared between each subjects within the group by using independent t-test. Both SA-RME and SA-PSE group showed stable results, but SA-PSE group showed statical significance in tipping movement of second premolar. We compared 6 patients who recieved SA-RME with 6 patients who received SA-PSE, and appraised the clinical usefulness.

• The korean journal of orthodontics
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• v.53 no.3
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• pp.175-184
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• 2023

Objective: To evaluate and compare a series of volume changes in the nasal cavity (NC), nasopharynx, oropharynx, and maxillary sinuses (MS) in growing Class III patients after either rapid palatal expansion (RPE) or alternate rapid maxillary expansion and constriction (Alt-RAMEC) followed by facemask (FM) therapy, by using cone-beam computed tomography (CBCT). Methods: Forty growing Class III patients were retrospectively selected and divided into two matched groups: RPE/FM (14 females, 6 males; mean age, 9.66 ± 1.23 years) and Alt-RAMEC/FM groups (14 females, 6 males; mean age, 10.28 ± 1.45 years). The anteroposterior and vertical displacements of Point A, the volumes of the NC, nasopharyngeal, oropharyngeal, and MS were measured at different time points: pretreatment (T1), postexpansion (T2), and postprotraction (T3). Results: Both groups demonstrated significant maxilla advancement (by 1.3 mm) during expansion, with a statistically significant intergroup difference during protraction (RPE/FM, 1.1 mm; Alt-RAMEC/FM, 2.4 mm; p < 0.05) and throughout the treatment (RPE/FM, 2.4 mm; Alt-RAMEC/FM, 3.7 mm; p < 0.05). NC and nasopharyngeal airway volumes increased significantly in both groups after expansion, protraction, and treatment. The oropharyngeal and MS volumes increased in both groups after protraction and post-treatment. However, no volumetric differences were observed between the two groups. Conclusions: There was no significant difference in airway volume changes, including NC, nasopharyngeal, oropharyngeal airway, and MS, between RPE/FM and Alt-RAMEC/FM groups at different time points. Although there was significantly more forward movement after protraction in the Alt-RAMEC/FM group, the difference was deemed too small to be clinically relevant.

• The korean journal of orthodontics
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• v.31 no.6 s.89
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• pp.611-618
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• 2001

This is a case report of a 12.5-year-old girl who presented with moderate to severe anterior dental crowding and rotations. Treatment involved no extraction, but expansion of both the maxillary and the mandibular arches. Maxillary expansion was assisted by rapid palatal expansion despite the fact that this patient did not present with posterior crossbite. Crowding and rotations in both arches were corrected and good occlusal function and improved facial esthetic were achieved, with acceptable overbite and overjet. The application of rapid maxillary expansion in cases with no posterior crossbite, which has increased in recent years, calls for re-evaluation of the diagnostic basis and indications for the use of this technique.

• The Journal of Korea Assosiation for Disability and Oral Health
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• v.11 no.2
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• pp.72-75
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• 2015

Cerebral palsy is one of the most common disabilities of childhood, which affects movement and co-ordination. Individuals with cerebral palsy are susceptible to traumatic dental injuries. High occurrence of Class II malocclusion with prominent maxillary incisors appears to increase risk of trauma. However, due to fear of behavior management and lack of cooperation, clinicians have avoided orthodontic treatment in cerebral palsy patients. This case report demonstrates that modified rapid maxillary expansion can be used as a simple and effective method to correct ectopic eruption of maxillary incisor in cerebral palsy patient.

• The korean journal of orthodontics
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• v.51 no.3
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• pp.217-227
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• 2021

Maxillary transverse deficiency often manifests as a posterior crossbite or edge-to-edge bite and anterior crowding. However, arbitrary arch expansion in mature patients has been considered to be challenging due to the possible periodontal adverse effects such as alveolar bone dehiscence and gingival recession. To overcome these limitations, nonsurgical maxillary expansion of the basal bone has been demonstrated in young adults. However, the age range for successful orthopedic expansion has remained a topic of debate, possibly due to the underlying individual variations in suture maturity. This case report illustrates nonsurgical, miniscrew-assisted rapid palatal expansion (MARPE) in a 60-year-old patient with maxillary transverse deficiency accompanied by anterior and posterior crossbites, crowding, and gingival recession. The use of MARPE allowed relief of crowding and correction of the crossbite without causing significant periodontal adverse effects.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.4
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• pp.320-328
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• 2006

Purpose: The aim of this study was to evaluate the effects of pterygomaxillary separation on dimensional changes of dental arch following surgically-assisted rapid maxillary expansion (SARME). Patients and Methods: Eighteen adults who had been treated by SARME for transverse maxillary deficiency from May 2000 to August 2005 were evaluated. Thirteen patients (Group 1) were treated with subtotal Le Fort I osteotomy including pterygomaxillary separation and anterior midpalatal osteotomy. The same operation was performed in five patients (Group 2) except pterygomaxillary separation. Dental study casts were taken before operation and after removal of expansion device. And then, skeletal and dental parameters were measured pre- and post-operatively. Results: 1. Changes of mean interdental width 1) In group 1, mean maxillary interdental width was increased 70%($47{\sim}99%$), 95%($84{\sim}115%$), and 77%($57{\sim}94%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 2) In group 2, mean maxillary interdental width was increased 77%($59{\sim}100%$), 78%($45{\sim}107%$), and 86%($57{\sim}116%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 3) There was a statistical difference between the change of interdental width of group 1 and group 2 at first premolar(p<0.05). 2. Changes of mean interalveolar width 1) In group 1, mean maxillary alveolar bone width was increased 66%($42{\sim}84%$), 74%($42{\sim}104%$), and 57%($31{\sim}78%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 2) In Group 2, mean maxillary alveolar bone width was increased 73%($55{\sim}98%$), 67%($36{\sim}89%$), and 59%($48{\sim}73%$) of total expansion on canine, first premolar, and first molar region, respectively after retention. 3) There were no statistical differences between group 1 and group 2 at each teeth area. Conclusion: These results suggest that SARME without pterygomaxillary separation may allow the relatively equal expansion at both anterior and posterior teeth area and most amounts of maxillary interdental expansions were acquired with the expansion of the maxilla by SARME.

• The korean journal of orthodontics
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• v.53 no.4
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• pp.241-253
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• 2023

Objective: To evaluate the following null hypothesis: the skeletal and dentoalveolar expansion patterns in the coronal and axial planes are not different with two different types of microimplant-assisted rapid palatal expansion (MARPE) systems. Methods: Pretreatment (T0) and post-MARPE (T1) cone-beam computed tomography (CBCT) images of 32 patients (14 males and 18 females; mean age, 19.37) were analyzed. We compared two different MARPE systems. One MARPE system included the maxillary first premolars, maxillary first molars, and four microimplants as anchors (U46 type, n = 16), while the other included only the maxillary first molars and microimplants as anchors (U6 type, n = 16). Results: In the molar region of the U6 and U46 groups, the transverse expansion at the midnasal, basal, alveolar, and dental levels was 2.64, 3.52, 4.46, and 6.32 mm and 2.17, 2.56, 2.73, and 5.71 mm, respectively. A significant difference was observed in the posterior alveolar-level expansion (p = 0.036) and posterior basal-bone-level expansion (p = 0.043) between the groups, with greater posterior skeletal and alveolar expansion in the U6 group. Conclusions: Compared with the U46 group, the U6 group showed greater posterior expansion at the alveolar and basal-bone levels, with an almost parallel split. Both groups showed a pyramidal expansion pattern in the coronal view.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.31 no.5
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• pp.390-398
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• 2005

Purpose: The aim of this study was to evaluate the skeletal and dentoalveolar dimensional changes following surgically-assisted rapid maxillary expansion (SARME). Patients & methods: Thirteen adults who had been treated by SARME for transverse maxillary deficiency from May 2000 to December 2003 were evaluated. The SARME procedure was the subtotal Le Fort I osteotomy combined with pterygomaxillary separation and anterior midpalatal osteotomy. Dental study casts and posteroanterior cephalometric radiographs were taken before operation, after removal of expansion device, and follow up period. Nasal cavity width, skeletal and dentoalveolar parameters were measured pre- and post-operatively. Results: 1. Mean nasal cavity width was increased 12%$(0{\sim}21%)$ of total expansion after retention. 2. Mean maxillary interdental width was increased 70%$(47{\sim}99%)$, 95%$(84{\sim}115%)$, and 77%$(57{\sim}94%)$ of total expansion in the canine, the first premolar, and the first molar region, respectively after retention. 3. Mean maxillary alveolar bone width was increased 66%$(42{\sim}84%)$, 74%$(42{\sim}94%)$, and 57%$(31{\sim}78%)$ of total expansion in the canine, the first premolar, and the first molar region, respectively after retention. 4. Mean palatal vault depth was decreased 1.3 mm ($0.5{\sim}2.0$ mm) after retention. 5. Mean interdental and alveolar bone width of the mandibular canine and intermolar width of mandible were slight increased as maxilla was expanded after retention. 6. There were statistical differences between preoperative and postoperative values of nasal cavity, all maxillary interdental and interalveolar widths, palatal vault depth, mandibular interdental and interalveolar width of canine(paired t-test, p<0.05). 7. The maxillary interdental and alveolar bone width were decreased approximately 25% of total expansion by relapse at follow up period. Conclusion: In conclusion, most amounts of maxillary interdental expansions were acquired with the expansion of the maxilla by SARME. For preventing the relapse, approximately 25% of the overexpansion was needed.