Search Results (51)

Background: Midpalatal suture expansion is effective in both growing and adult patients, and Miniscrew-Assisted Rapid Palatal Expansion (MARPE) provides greater skeletal effects and fewer dentoalveolar side effects than traditional expanders. However, asymmetric expansion remains a challenge, often influenced by pre-existing craniofacial asymmetries, appliance design, and suture morphology. In this case report, we describe asymmetric expansion with 3D-guided piezocorticotomy-assisted MARPE and its management with directly printed aligners (DPAs). Methods: A patient with facial asymmetry, a narrow maxillary arch, and multiple dentoalveolar deformities underwent pre-treatment evaluation, including root inclination analysis and CBCT imaging. A MARPE appliance with 3D-guided piezocorticotomy assistance was applied; post-expansion orthodontic treatment was digitally planned and performed with directly printed aligners. Results: During MARPE activation, asymmetric midpalatal suture disarticulation was observed, with greater displacement on the left side due to jackscrew orientation and root proximity. Post-expansion orthodontic correction with DPAs allowed precise root positioning, spatial redistribution, and improved occlusal symmetry. Over 20 months, significant improvements were achieved in midline orientation, axial root inclination, and transverse arch coordination. Conclusions: The reported case underscores the importance of pre-treatment evaluation for asymmetries and careful appliance design in MARPE protocols; in addition, it demonstrates that directly printed aligners, supported by digital planning, can provide accurate and efficient dentoalveolar correction following asymmetric expansion. Full article

Background/Objectives: The nasomaxillary complex is a compound anatomical structure in which the correlation between changes in palatal width and height has been poorly investigated. Methods: A three-year prospective study with 28 patients treated with printed expanders was conducted. Measurements on CBCT images were performed before and after treatment; the width and height parameters were measured on a coronal slice of a CBCT image at the level of the first molars and upper first molar inclination relative to the palatal plane. Results: A significant difference was found between the values measured before and after treatment, including an increase in the measured width parameters and a statistically significant decrease in palatal height (0.75 ± 0.97). The mean change in the upper molar inclination was not significant (tooth 16: 0.60 ± 6.42; tooth 26: 2.19 ± 4.51). The regression analysis did not establish a significant correlation between the expansion of the maxillary occlusal width and palatal height change or a significant correlation between the increase in the upper molar inclination and palatal height change. Conclusions: The use of a printed tooth-borne expander causes predictable and reproducible skeletal changes. It is a feasible treatment option, allowing for precise screw positioning to achieve bodily movement of the teeth and decrease the change in molar inclination. Full article

Objectives: The current study aimed to summarize the current evidence on vertical control provided by the bonded rapid palatal expander (BRPE) in pediatric patient populations within 6 months after expansion. Methods: Relevant studies were screened independently by two researchers from the eight databases MEDLINE (PubMed), Web of Science, SCOPUS, Embase, Cochrane, LILACS (Latin American and Caribbean Health Sciences Literature), LIVIVO and Google Scholar, and supplemented by a manual search of the reference lists from studies selected for full-manuscript reading. Relevant data from lateral cephalograms taken pre- and post-expansion was extracted. A meta-analysis was performed with RStudio and a risk of bias assessment of the included articles was completed. Results: Ten relevant studies were included for data extraction, although most had a high risk of bias. The meta-analysis revealed that within 6-month retention after BRPE treatment, there were (1) slight increases in total (0.83 mm), upper (0.57 mm), and lower (0.70 mm) facial height; (2) minimum change in the palatal plane angulation (−0.01°); (3) minimum change in the occlusal angulation (−0.04°); and (4) minimal mandibular plane angulation changes with 0.01° increase in SN-GoGn angle, 0.71° increase in SN-MP angle, 0.17° increase in FMA, and 0.82° increase in PP-GoGn angle. Conclusions: Current evidence indicates that BRPEs may not control or reduce the vertical dimension significantly within 6 months after expansion. Further high-quality studies, particularly on hyperdivergent patients, are needed to clarify whether bonded expanders offer advantages over traditional banded expanders in management of the vertical dimension. Full article

The Maxillary Skeletal Expander (MSE) is used for maxillary expansion in adolescents and young adults. Virtual planning using 3D models, CBCT and 3D printers help in case selection, appliance design and fabrication. Using the proposed digital workflow, the accuracy of the patient selection phase and appliance delivery are increased, and the required number of visits to the clinic is decreased. The MSE serves as a guide for the insertion of mini-implants, reducing the number of appointments needed for installation. (1) Introduction: Mini-Implant-Assisted Rapid Palatal Expansion (MARPE) appliances, like the MSE, decrease the side effects that regular tooth-anchored appliances have on dental and periodontal structures, especially for skeletally mature patients, combining palatal anchorage with dental support for guidance. The digital planning of the insertion sites, length and angulation of the mini screws, and the fabrication of the 3D-printed appliance that stands as a mini-implant insertion guide give an undeniable precision. (2) Materials and methods: The laboratory steps used in the digital design and fabrication, and clinical steps needed for the insertion protocol are described. (3) Discussions: The individual assessment of the anatomical structures and the use of virtual integrated dental impressions and CBCT increase the accuracy of diagnosis, appliance fabrication and treatment progress. Implementing a digital workflow for mini-implant-supported expansion is a real advantage for both dental teams and patients. (4) Conclusions: The wide range of advantages and the ease of the process support the introduction of this digital workflow in every orthodontic practice. Full article

Background: Obstructive sleep apnea (OSA) is a prevalent disorder in both pediatric and adult populations, characterized by substantial morbidity encompassing cardiovascular, neurocognitive, and metabolic impairments. Management strategies vary by age group and underlying etiology, with orthodontic and non-orthodontic interventions playing key roles. This narrative review synthesizes the current evidence on orthodontic and non-orthodontic therapies for OSA in pediatric and adult populations, emphasizing individualized, multidisciplinary care approaches and highlighting future research directions. Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar to identify studies on diagnosis and management of OSA in children and adults from 2000 to 2025. Results: In pediatric patients, treatments such as rapid maxillary expansion (RME), mandibular advancement devices (MADs), and adenotonsillectomy have shown promising outcomes in improving airway dimensions and reducing apnea–hypopnea index (AHI). For adults, comprehensive management includes positive airway pressure (PAP) therapy, oral appliances, maxillomandibular advancement (MMA) surgery, and emerging modalities such as hypoglossal nerve stimulation. Special attention is given to long-term treatment outcomes, adherence challenges, and multidisciplinary approaches. Conclusions: The findings highlight the need for individualized therapy based on anatomical, functional, and compliance-related factors. As the understanding of OSA pathophysiology evolves, orthodontic and adjunctive therapies continue to expand their role in achieving durable and patient-centered outcomes in sleep apnea management. Full article

The purpose of this systematic review is to analyze the dentoalveolar changes resulting from the use of clear aligners in the treatment of transverse maxillary deficiency among growing children in the mixed dentition stage. An electronic literature search was carried out using the following databases: PubMed, Scopus, Cochrane Library, Embase, and Web of Science. The review protocol was prospectively registered in the PROSPERO database. Eligible studies included children aged 6 to 12 years in the mixed dentition period, presenting with erupted maxillary first molars and a transverse deficiency of the maxilla, and undergoing treatment with Invisalign^® First aligners. The review encompassed various study types including retrospective and prospective designs, randomized controlled trials, preliminary studies, and case series. Two independent reviewers conducted the data extraction process. The quality of evidence was assessed using the GRADE approach. Except for studies by Bruni et al., the risk of bias in selected articles was visually summarized in a traffic light plot using the robvis tool, following the ROBINS-I methodology. For the studies by Bruni et al., a separate visual representation was created using robvis with the RoB2 evaluation framework, prepared by the authors S.E.I. and C.A. In total, 14 studies were included in the final synthesis, selected from 265 records retrieved through electronic searches and an additional 36 identified via manual screening. Several parameters were considered in order to assess dentoalveolar expansion: intercanine width, intercanine transpalatal width, intercanine dentoalveolar width, first and second interdeciduous molar width, first and second interpremolar width, first and second interdeciduous molar transpalatal width, first intermolar width, first intermolar mesial, distal, and transpalatal width, molar inclination, arch depth, and arch perimeter, and intermolar dentoalveolar width. An improvement was recorded in all parameters. The studies comparing treatment with Invisalign^® First clear aligners and rapid maxillary expander highlighted that these both determined statistically significant differences compared to the natural growth group. Treatment with Invisalign^® First in mixed dentition proved to be very effective for dentoalveolar expansion of the maxillary arch, with good control of the crown angulation of the upper first molar and an increase in the palatal area similar to RME, compared to pre-treatment or to the natural growth group. It could represent an effective and comfortable alternative to the traditional rapid maxillary expander treatment. However, further high-quality studies are required to support our current observations and verifying the stability of treatment outcomes on a long-term basis. Full article

The rapid maxillary expander is one of the most widely used devices in orthodontics, and this study analyzes the skeletal and dental effects of a two-band rapid maxillary expander (RME) and a splint resin palatal expander (SRPE) in growing children with skeletal maxillary contraction. Seventy-four subjects with palatal skeletal contraction and unilateral or bilateral posterior crossbite were treated using maxillary expander devices. The sample was made up of two different randomly assigned groups: RME (21 females, 17 males; mean age ± SD 7.7 ± 1.1 years) and SRPE (24 females, 15 males; mean age ± SD 7.6 ± 1.0 years). The effects of these two different devices were evaluated based on lateral cephalograms and measurements of digital models before and after treatment (7.0 ± 1.0 months). Longitudinal changes in the different groups were evaluated statistically using Student’s t-test (p < 0.05). No significant differences in treatment effects were found for any vertical or sagittal skeletal variables in the groups. However, there was a significantly increased maxillary intercanine distance in the SRPE group (36 patients; mean ± SD = 6.0 ± 4.8 mm) compared to the RME group (38 patients; mean ± SD = 3.1 ± 2.9 mm). The results of this study showed an increase in vertical skeletal dimensions in more patients treated using SRPE than RME. Moreover, the SRPE device was shown to be better at increasing the intercanine distance, and it could therefore be preferred in children with anterior dental crowding. An evaluation of long-term treatment stability would be useful to confirm the study results. Full article

Background/Objectives. With a rapid palatal expander (RPE) is reported to be effective in increasing the volume of nasal cavities, with a restoration of physiological nasal airflow. The purpose of this retrospective clinical study was to evaluate, using Cone Beam Computed Tomography (CBCT), the volumetric changes and airflow velocity changes in the nasal cavities, retro-palatal and retro-glossal airways, resulting from the use of RPE with dental anchorage (group A), also comparing these data with patients non treated with RPE (group B). Methods. Sixteen subjects (aged 9.34 years) with transverse maxillary deficiency and unilateral posterior crossbite were treated with RPE with dental anchorage. Additionally, 8 patients (aged 11.11 years) with juvenile idiopathic arthritis, who did not undergo any orthodontic treatment, were selected as a control group. Expansion was performed until overcorrection was achieved, and the device was left in place for 6 months as fixed retention, followed by another 6 months of night-time removable retention. From the retrospective evaluation, all patients presented two CBCT scans at baseline (T0) and 1-year follow-up (T1). The 3D-Slicer software was used for each CBCT to measure the nasal (VN), retropalatal (VRP), and retroglossal (VRG) volumes, while an iterative Excel spreadsheet allowed for a pilot approximated modeling and calculation of airway flow-related data. Results. Regarding mean age, a statistically significant difference (p = 0.01 *) was found between groups, suggesting that group B is closer to the pubertal growth peak. Analysis between T0 and T1 revealed: (i) a statistically significant increase for volumes VN, VRP and VRG in group A; (ii) a statistically significant increase for VN in group B; (iii) a statistically significant decrease for all variables related to airflow velocity in both groups. Furthermore, comparison between group A and B, regarding variations between T0 and T1, found a statistically significant difference only for VN. Conclusions. Within the limitations of this pilot evaluation, the treatment with RPE revealed promising outcomes for retro-palatal, retro-glossal and nasal volumes, together with clinical changes in airflow velocities. Full article

Objective: This paper aimed to assess the effectiveness of the Rapid Maxillary Expander (RME) II System, compared to the Sander bite-jumping appliance (SBJ) and an untreated control group, in the treatment of Class II skeletal malocclusion in children. Methods: Thirty Class II patients treated with the RME II System (Group R) were compared to 30 patients treated with the SBJ (Group S) and 30 untreated Class II children (Group C). Cephalograms were analysed at the beginning of the study (T0) and at the end of the treatment (T1). Eight cephalometric parameters were evaluated: the divergence angle (SN-MP), ANB, lower face height (LFH), CO-GN, 1 + SN, IMPA, overjet, and overbite. The Shapiro–Wilk normality test was conducted to assess the distribution of the data. A t-test was then used for pairwise comparisons of the cephalometric measurements between T0 and T1. Differences among the groups were analysed using one-way ANOVA with Tukey’s post hoc correction. Results: ANOVA revealed a statistically significant difference for all analysed variables except 1 + SN. The post hoc Tukey’s test identified the following differences: SN-MP was 2.51° greater in Group S than in Group R, LFH was 5.46 mm greater in Group C than in Group R and 3.11 mm greater in Group S than in Group R, IMPA was 4.01° greater in Group S than in Group R, and overbite was 1.96 mm lower in Group S than in Group R. Conclusions: The RME II System provides better control of mandibular plane inclination and lower incisor proclination during the correction of Class II skeletal malocclusion. Both devices are effective in correcting Class II skeletal malocclusion. Full article

Background/Objectives: Rapid palatal expansion is commonly used to correct maxillary deficiencies. However, medications like Isotretinoin may influence bone remodeling during treatment. Isotretinoin, a drug used to treat acne, was the focus of this study, which aimed to evaluate its effect on bone repair after rapid palatal suture expansion in rats. Methods: The sample consisted of 40 Wistar rats, divided into two groups: the control group (CG), subjected only to orthodontic movement, and the experimental isotretinoin group (IG), where movement occurred after drug administration. Periods of 0, 7, and 14 days after the installation of the orthodontic device were analyzed, with a force of 30 g applied in all groups using a steel spring. After euthanasia, the maxillae were removed and analyzed via Micro-CT, histologically, and histomorphometrically. Results: The results showed that the expander was effective in promoting the expansion of the palatal suture. After 14 days, the total expansion was 381% (CG) and 299% (IG); the percentage of vessels in the connective tissue increased by 145% in CG and 84% in IG; and bone formation in both groups occupied 52% of the expanded palatal suture. No significant differences were observed between the groups regarding collagen fiber formation. Conclusions: It was concluded that the daily administration of Isotretinoin at the standard dose for the treatment of severe acne does not cause significant alterations in the bone repair process following the opening of the median palatine suture in rats. Full article

Rapid or semi-rapid maxillary expansion is a well-established method of treating severe transversal maxillary deficiency or transversal dental arch discrepancy. Pain is considered an inevitable undesirable adverse effect of orthodontic treatment. The aim of the present study was to compare pain levels experienced from the semi-RME (SRME) procedure between adults and adolescents and the lower fixed appliance (FA) procedure in the same patients. The study comprised 95 patients (51 adults and 44 adolescents) treated with a bonded acrylic Hass-type expander and the following month (after blocking the screw) with a lower fixed orthodontic appliance. Pain was assessed using a numerical rating scale from 0 to 10. During screw activation, adolescent patients reported a statistically significantly higher median pain level (5.00) compared to adults (3.00) [p = 0.009]. During the fixed appliance treatment, adolescent patients reported similar pain level to adults (4.5 and 4.0, respectively; p = 0.49). Interestingly, the median pain level for SRME in the whole group was 4, and was not different from the fixed appliance treatment sensations. Adolescent females had the highest pain sensation, while adult males had the lowest during both procedures, SRME and FA. The difference between the midpalatal suture opening (appearance of diastema) in adolescents (81.82%) vs. adults (64.71%) was not statistically significant (p = 0.062). The oldest patients with diastema were a 36y-2mo-old man and a 42-year-old woman, whereas the youngest patients without diastema were an 11y-11mo-old girl and a 13y-2mo-old boy. Moreover, all female patients between 30 to 42 years of age (eight women) had presented with diastema. In both age groups, the biggest disadvantage during SRME, reported by 50.53% of all patients (45.45% of adolescents and 54.9% of adults; p = 0.062), were speech problems, whereas only 18.95% of the total group (27.27% of adolescents vs. 11.76% of adults; p = 0.054) considered pain as the main disadvantage. During FA therapy, 32.63% of all patients reported pressure sores as the main disadvantage (29.55% of adolescents and 35.29% of adults; p = 0.551). Full article

Background: This case report describes the clinical management of a traumatic palatal ulcer, a complication associated with mini-implant-assisted rapid maxillary expansion (MARPE). Case Report: A 13-year-old female patient with maxillary constriction underwent MARPE treatment using a custom acrylic expander anchored by four mini-implants. Despite proper planning and device design, the patient missed her first follow-up appointment and continued activations, resulting in tissue inflammation and embedding of the device. Upon examination, swelling and displacement of the cement were observed, necessitating device removal. The traumatic ulcer was treated with chlorhexidine gel, paracetamol, and a soft diet. Complete recovery was achieved within one month. A second expander was then designed and installed, with more frequent monitoring and improved hygiene protocols. This approach led to successful expansion without complications. This case highlights the importance of precise treatment planning, proper mini-implant selection, and regular follow-ups in MARPE therapy. It also emphasizes the need for patient compliance and effective hygiene measures to prevent complications. Conclusions: The successful management of the traumatic ulcer demonstrates that prompt action and consideration of cost-effective treatment options can lead to positive outcomes in addressing MARPE-related complications. Full article

Background: Whether Hyrax maxillary expander is an effective treatment for maxillary transverse deficiency as well as expansion of the upper airway is still controversial. The study’s purpose was to evaluate 3D changes in upper airway dimensions of adolescent patients measured primarily by cone-beam computed tomography (CBCT) after rapid maxillary expansion (RME) with the Hyrax maxillary expander. Methods: Studies up to 1 April 2024 were searched in the following databases: PubMed/MEDICINE, Web of Science, Cochrane Library, and Embase. Inclusion criteria were clinical trials and cohort studies that assessed the effect of RME in adolescent patients with upper airway stenosis using CBCT-based three-dimensional analysis. The risk of bias in the study outcomes was assessed using the Cochrane Collaboration’s risk of bias tool, the GRADE method, and a tool for evaluating non-randomized controlled study (non-RCT) literature from a previous systematic review, depending on the types of articles. The study was reported in accordance with PRISMA guidelines. Results: The study conducted a random effects meta-analysis of mean differences and 95% confidence intervals for changes in upper airway volumes, including the nasal cavity (NC), in the outcomes of 16 included studies, followed by subgroup analyses. Conclusion: A significant increase in nasopharynx volume was observed after rapid maxillary expansion (RME) by Hyrax maxillary expander (MD = 0.69, 95% CI (0.09~1.28), p = 0.02). Full article

(1) Background: The objective of this study was to evaluate the efficacy of the Rapid Maxillary Expander (RME) II System compared to a Herbst appliance and a control group in the treatment of class II skeletal malocclusions in growing patients. (2) Methods: A total of 30 class II patients treated using the RME II System (group R) were compared with 30 patients treated with a Herbst appliance (group H) and 30 untreated class II children (group C). Cephalograms were compared at the start (T0) and after 24 months (T1). Nine cephalometric parameters were analyzed: SN-MP, SN-PO, ANB, AR-GO-ME, AR-GO-N, N-GO-ME, SN-PP, LFH, CO-GN, 1+SN, IMPA, OVERJET, and OVERBITE. Since the variables failed the normality test, a Wilcoxon test was performed for a pairwise comparison of the cephalometric measurements taken at T0 (pre-treatment) and at T1 (post-treatment). ANOVA with Tukey post hoc correction was used to evaluate the differences among the groups. (3) Results: ANOVA showed a statistically significant difference for all analyzed variables except for AR-GO-ME, AR-GO-N, and N-GO-ME. Post hoc Tukey’s HSD test showed the following difference: the SN-PO angle in group H was 3.59° greater than in group R; the LFH in group H was 4.13 mm greater than in group R. The mandibular length (CO-GN) in group H was 3.94 mm greater than in group R; IMPA in group H was 6.4° greater than in group R; and the ANB angle in group H was 1.47° greater than in group R. (4) Conclusions: The RME II System is an effective therapeutic device for class II skeletal malocclusion treatment in growing patients. Full article

One of the important parameters in orthodontics is the perimeter of the dental arch. Precise assessment is necessary in cases of maxillary constriction treated with a rapid maxillary expander (RME). The orthodontic software allows customization of the processes from diagnosis to manufacturing of the treatment device. The aim of the present study is to evaluate a relationship between the parameters of the dental arch—perimeter, width, and length—and to follow the changes during treatment. The study is based on the digital measurements of 3D models of 33 patients treated with a digitally planned and printed RME. In the results an increase of 3.99 mm in perimeter was achieved. The rest of the parameters were changed as follows: The width of the dental arch was increased in the premolar area by an average of 3.3 mm; in the area of the first molars, the increase was 4.41 mm; the length of the dental arch in the anterior segment was reduced by an average of 0.54 mm; and the whole length by 0.52 mm. Correlation between the studied variables was described by linear equations. In conclusion, rapid maxillary expansion is a reliable method for gaining predictable space in the dental arch. Full article