Narrow Maxilla
Conditions
Keywords
MARPE, Endognathia, rhinomanometry
Brief summary
Transverse maxillary deficiency is a common orthodontic issue, affecting around 10% of adults. Late adolescents and adults often require more force to expand the midpalatal suture due to its increased interdigitation. This study aims to assess the effectiveness of MARPE in this demographic and determine the best activation protocol for non-surgical maxillary expansion using mini-screw-supported appliances. Additionally, the study will evaluate the effectiveness of MARPE on nasal permeability and airway volume.
Detailed description
The study design comprised a three-arm, parallel-group randomized controlled trial (RCT) conducted at the Orthodontics clinic of Brussels University Hospital. Patients were randomly allocated into one of three groups: 1. Continuous rapid activation protocol: Patients received one activation of 0.17 mm per day until reaching the clinical goal. 2. Continuous slow activation protocol: Patients underwent two activations (0.33 mm) per day for the first 7 days, followed by one turn forward every third day (0.17 mm / 3 days). 3. Force-controlled polycyclic protocol: Patients underwent two activations (0.33 mm) per day for the first 7 days. Then, the hex nut was turned 6 sides backward, followed by 6 sides forward after 15 minutes. Additionally, the device was activated by 0.17 mm every third day. Intervention: All patients underwent maxillary expansion with MARPE. Four orthodontic mini-screws were inserted under local anesthesia using a surgical guide and motor. Surgical incision was not required, and predrilling was performed if necessary. The MARPE remained in place for 12 months after expansion to allow bone remodeling in the midpalatal suture. Fixed straight-wire treatment commenced 2 months after expansion termination. Patients underwent retention check-ups at 6 and 12 months post-expansion, and expansion screws and mini-screws were removed after 12 months or before orthognathic surgery, if applicable. The specific aims of the study were to evaluate the success rate of nonsurgical maxillary expansion, compare the efficacy of the three activation protocols, assess and compare complications, analyze the correlation between success rate and Midpalatal Suture Maturation Stage (MPS), age, and sex, and measure nasal permeability variation using anterior rhinomanometry.
Interventions
DEVICEMini-implants assisted maxillary expansion
The intervention involved the placement of orthodontic mini-screws in the patient's palate, varying in diameter from 2 to 2.3 mm and in length from 11 to 15 mm. After mini-screw insertion, another intraoral scan was taken for the fabrication of the appliance. Approximately three weeks later, the expander was placed in the patient's palate, and maxillary expansion was initiated immediately afterward according to the chosen protocol.
Sponsors
Erasme University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
16 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* from the age of 16 onwards * who presented with transverse maxillary discrepancy (unilateral, bilateral, anticipated, or constriction without crossbite).
Exclusion criteria
* history or presence of maxillofacial surgery, cleft lip and palate, craniofacial anomalies or syndromes, congenital tooth anomalies, and periodontal disease. * Patients who had previously palatal expansion were excluded also. * Presence of anatomic or pathological obstacle of the palatal mini-screw insertion (impacted tooth, tumor.) * refusal of study participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| TI : tooth inclination | up to 6 months | 2D inner angle (in degrees) between the palatal plane and the left and right line running through the palatal apex and the mesiobuccal fossa or the mesial fossa |
| ZMA | up to 6 months | width in millimeters between the right and left zygomatic arches at its widest point at the most inferior level of the orbits. |
| LID: | up to 6 months | distance in millimeters from the most external point of the right zygomaticomaxillary suture to the most external point of the left zygomaticomaxillary suture |
| NCW: nasal cavity width | up to 6 months | Transverse distance in millimeters between the left and right most lateral point of the nasal cavity |
| MSW: midpalatal suture width | up to 6 months | Transverse distance in millimeters between the medial limits of the left and right palatal process at the palatal floor |
| IMW: intermolar width | up to 6 months | Transverse distance in millimeters between the left and right maxillary M1 mesiocentral fossae |
| IPW: interpremolar width | up to 6 months | Transverse distance in millimeters between the left and right maxillary P1 mesial fossae |
| ICW: intercanine width | up to 6 months | Transverse distance in millimeters between the left and right maxillary canine buccal cusp tips |
| PAW: palatal alveolar width | up to 6 months | Transverse distance between in millimeters the left and right most cervical medial limits of the palatal alveolar process |
| MPSM: mid-palatal suture middle molars | up to 6 months | the width of the mid-palatal suture measure in millimeters at the level of the first molars |
| ANS-ANS | up to 6 months | the distance in millimeters between the right anterior nasal spine and the left anterior nasal spine after the maxillary expansion |
| PNS-PNS | up to 6 months | distance in millimeters between the right posterior nasal spine and the left posterior nasal spine after the maxillary expansion |
| UID | up to 6 months | distance in millimeters from the most external point of the right frontozygomatic suture to the most external point of the left frontozygomatic suture. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| OMCSA: oropharynx minimum cross-sectional area | up to 6 months | oropharynx minimum cross-sectional area in mm2 |
| AV: Accumulated volume | up to 6 months | which represents the total volume in mm3, is calculated using the sum of the NCV, RMSV, LMSV, NPV, and OPV |
| RT resistance total | up to 6 months | Total bilateral nasal resistance in Pa.s.cm³ |
| NCV: nasal cavity volume | up to 6 months | nasal cavity volume in mm3 |
| RMSV : right maxillary sinus volume | up to 6 months | Right maxillary sinus volume in mm3 |
| LMSV : left maxillary sinus volume | up to 6 months | left maxillary sinus volume in mm3 |
| NPV nasopharynx volume | up to 6 months | nasopharynx volume in mm3 |
| OPV oropharynx volume | up to 6 months | OPV oropharynx volume in mm3 |
Countries
Belgium
Contacts
Primary Contactarnel NANA, Dr
Outcome results
None listed