Comparison of mini-screw-assisted rapid maxillary expansion in adolescents with different body mass indices: a prospective clinical study

Publications

Share / Export Citation / Email / Print / Text size:

Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine

GET ALERTS

ISSN: 2207-7472
eISSN: 2207-7480

DESCRIPTION

0
Reader(s)
0
Visit(s)
0
Comment(s)
0
Share(s)

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue / page

Archive
Volume 38 (2022)
Volume 37 (2021)
Volume 36 (2020)
Volume 35 (2019)
Volume 34 (2018)
Volume 33 (2017)
Volume 32 (2016)
Volume 31 (2015)
Related articles

VOLUME 38 , ISSUE 1 (January 2022) > List of articles

Comparison of mini-screw-assisted rapid maxillary expansion in adolescents with different body mass indices: a prospective clinical study

Suleyman Kutalmış Buyuk * / Huseyin Simsek * / Sedanur Hatal * / Nilge Sarımehmetoglu * / Didem Odabası *

Citation Information : Australasian Orthodontic Journal. Volume 38, Issue 1, Pages 41-50, DOI: https://doi.org/10.21307/aoj-2022.005

License : (CC-BY-4.0)

Received Date : October-2021 / Accepted: December-2021 / Published Online: 17-January-2022

ARTICLE

ABSTRACT

Objectives:

The objective of the present study was to compare the dentoskeletal effects of mini-screw-assisted rapid maxillary expansion (RME) in children with different body mass index (BMI) percentiles.

Study design:

The study was performed on 20 patients who were divided into two groups based on their BMI percentiles as normal-weight (n = 10) and overweight-obese (n = 10). The linear, angular and area analyses were performed on lateral and postero-anterior cephalometric radiographs and three-dimensional dental models before and after RME therapy.

Results:

A statistically significant increase was observed in maxillary intermolar and intercanine distances and palatal area measurements in both groups (P < 0.05). There was no significant difference between the two groups when dental RME changes were measured on 3D models. A significant difference was observed in latero-nasal and maxillo-mandibular width as well as postero-anterior cephalometric parameters between the groups (P < 0.05). While a significant change was observed in the SN-GoMe, FMA, Z angle, Wits appraisal, total anterior facial height and lower anterior facial height parameters in the normal-weight group (P < 0.05), a statistically significant change was observed in the gonial and nasolabial angles in the overweight-obese group.

Conclusions:

Mini-screw-assisted RME treatment significantly increased maxillary intermolar and intercanine width, and the palatal area in both groups; however, there was no significant difference between the BMI groups.

Graphical ABSTRACT

Introduction

The number of overweight and obese individuals is increasing at an alarming rate in both developing and developed countries. According to the World Health Organization, childhood obesity has become a significant health problem as it rapidly increases. Based on predictions, 254 million children aged 5 to 19 are projected to become obese by 2030.1 While obesity is generally related to high calorie intake and low physical activity, genetic factors and hormonal disorders may also play a role. Obesity can lead to an increase in skeletal growth by amplifying bone density. Accordingly, it is known that obese children complete their cervical vertebral maturation prematurely when compared to their normal-weight peers.2–4

Rapid maxillary expansion (RME) is a method frequently applied to treat a maxillary transverse deficiency in children and adolescents.5,6 A variety of expansion devices have been developed but tooth-borne appliances have been mostly used. The disadvantages of tooth-borne expansion appliances involve the buccal tilting of the supporting teeth and a potential increase in gingival recession. Contemporary bone-borne RME appliances are used as an alternative to tooth-borne appliances to overcome the tipping disadvantages.7–10

The objective of the present study was to compare the dento-skeletal effects of mini-screw-assisted RME in children of different body mass index (BMI) percentiles by analysing postero-anterior (P-A) and lateral cephalometric radiographs in additional to three-dimensional (3D) models.

Materials and methods

The study was conducted with the approval of Ordu University Local Ethics Committee (2018/95) on 20 patients (17 female, 3 males; mean age: 13.60 ± 1.39) who presented to Ordu University Faculty of Dentistry Department of Orthodontics for orthodontic treatment. Each patient complained of a unilateral or a bilateral buccal crossbite resulting from a maxillary transverse deficiency. Informed consent was obtained from the parents prior to commencement. Individuals with poor oral hygiene, severe periodontal disease, a systemic disorder, a craniofacial anomaly, or a history of previous orthodontic treatment were excluded from the study. The sample size was calculated using the G*Power software program (version 3.1.9.2; Axel Buchner, Universität Düsseldorf, Düsseldorf, Germany) and the total sample size required to identify a moderate effect (0.60) with 80% power was found to be 19.

The patients were divided into two groups based on their BMI percentiles: the participants in the first group were normal-weight individuals (n = 10), while the second group was comprised of overweight and obese individuals (n = 10). The patients in both groups received intraoral and extraoral orthodontic photographs plus impressions and their chronological ages were recorded at their first appointments. The body weight and height calculations were performed using a digital scale with a sensitivity of 0.1 kg and a 1 mm graduation stadiometer.

The lateral cephalometric and P-A cephalometric radiographs were captured by a cephalometer (Kodak 8000C Digital Panoramic and Cephalometric System, Cephalostat, Corestream Health Inc. Rochester NY, USA), while the patient was in natural head position with their lips relaxed. The patient’s dental models were obtained and pre-treatment intraoral and extraoral photographs were also recorded.

A mini-screw-assisted RME appliance was designed for each patient. After an intra-oral fit of the appliance was checked by the clinician, mini-screw holes were placed in the acrylic. Following palatal local anaesthesia, four mini-screws, two on the right and two on the left side, were inserted between the first and second premolars and the mesial area of the first molar (Fig. 1). The parents were instructed about the screw-turning protocol after the placement of the appliance.

Figure 1.

Mini-screw-assisted rapid maxillary expansion.

10.21307_aoj-2022.005-f001.jpg

For both groups, the expansion screw was activated one-quarter of a turn in the morning and in the evening (one-quarter turn: 0.2  mm) during the first week. After fourteen-quarter turns had been activated, a daily one-quarter-turn routine was performed during the following weeks. The screw-turning protocol was maintained until the palatal cusps of the maxillary first molar were aligned with the buccal cusps of the mandibular first molar. Following the completion of the active expansion, the expansion screw was fixed by composite resin cured in the screw mechanism and the appliance was passively intraorally maintained for three months. After the retention phase, lateral and P-A cephalometric radiographs, dental models, intraoral and extraoral photographic records were taken.

The linear and angular measurements determined on lateral and P-A cephalometric radiographs were carried out using cephalometric software (Facad, trial version, Linkoping, Sweden) (Figs. 2–4).

Figure 2.

(1) SNA, (2) SNB, (3) ANB, (4) gonial angle, (5) SN/GoMe, (6) FMA, (7) FMIA, (8) IMPA, (9) U1/SN, (10) nasolabial angle, (11) Z angle.

10.21307_aoj-2022.005-f002.jpg
Figure 3.

(1) Wits appraisal, (2) total anterior facial height, (3) lower anterior facial height, (4) U6/PP, (5) L6/MP.

10.21307_aoj-2022.005-f003.jpg
Figure 4.

(1) Bizygomatic width, (2) lateronasal width, (3) maxillomandibulare width, (4) maxillare width.

10.21307_aoj-2022.005-f004.jpg

The plaster models were scanned by a three-dimensional scanner (3 Shape Trios 3, Copenhagen, Denmark) and the acquired data converted into an .stl format. Linear and area measurements were performed on the pre-treatment and post-treatment model images using a dedicated program (Mesh Mixer, USA) (Figs. 5, 6).

Figure 5.

(1) Intercanine width, (2) palatal area, (3) intermolar width.

10.21307_aoj-2022.005-f005.jpg
Figure 6.

(1) Intercanine width, (2) intermolar width.

10.21307_aoj-2022.005-f006.jpg

To determine examiner reliability, all measurements were repeated by one researcher on randomly-selected radiographs and model images after 3 weeks.

Statistical analysis

The statistical analysis was carried out using the SPSS software program (SPSS Inc., Windows compatible version 20; Chicago, IL, USA). The data distribution was evaluated by applying the Shapiro–Wilk test of normality. The independent t-test was applied to the normally distributed parameters, while the Mann–Whitney U test was applied to the parameters not showing a normal distribution for the intergroup comparison of cephalometric and model measurements. For the within-group comparison of values, the paired t-test was applied to the normally distributed parameters, while the Wilcoxon signed-rank test was applied to the values not showing a normal distribution. A value of P < 0.05 was acknowledged to be statistically significant.

Results

Of the individuals included in the present study who successfully completed the RME procedure, the mean age was 13.85 ± 1.37 in the normal-weight group and 13.35 ± 1.44 in the overweight-obese group. There was no statistically significant difference related to age between the two groups (P > 0.05). The study initially recruited 24 patients; however, three patients from the normal-weight group and one patient from the overweight-obese group were excluded from the study due to poor oral hygiene-induced gingival hyperplasia, and mini-screw loss and lack of hygiene, respectively.

The intra-class correlation coefficients for all measurements were > 0.920, confirming measurement reliability.

The comparison of the initial lateral cephalometric film values of both groups is provided in Table I. The values were found to be similar in each group (P > 0.05). The intra-group comparison of the changes in the lateral cephalometric parameters induced by RME is shown in Table II. While a significant change was observed in the ANB, SN-GoMe, Z angle, Wits appraisal, total anterior facial height and lower anterior facial height parameters in the normal-weight group (P < 0.05), a statistically significant change was observed in the gonial and nasolabial angles in the overweight-obese group. Changes occurring in other lateral cephalometric radiograph parameters were not statistically significant (P > 0.05). The comparison of differences occurring in lateral cephalometric radiographic measurements before and after the RME treatment is shown in Table III. A statistically significant difference was observed only in nasolabial angle parameters upon comparing the cephalometric changes between the groups (P < 0.05).

Table I.

Comparison of initial (T0) lateral cephalometric between groups.

10.21307_aoj-2022.005-t001.jpg
Table II.

Changes (T1-T0) in Normal weight and overweight-obese groups.

10.21307_aoj-2022.005-t002.jpg
Table III.

Comparison of evaluated parameter changes (T1–T0) between groups.

10.21307_aoj-2022.005-t003.jpg

A comparison of the initial P-A cephalometric film values of both groups is shown in Table I. The values were found to be similar in each group (P > 0.05). The intra-group comparison of the RME-induced changes is shown in Table II. A statistically significant increase in latero-nasal and maxillary widths was observed in the P-A radiographic measurements of the overweight-obese group (P < 0.05). The changes occurring in P-A parameters in the normal-weight group were not statistically significant (P > 0.05). A comparison of the differences in P-A radiographic measurements before and after RME treatment is presented in Table III. There was a significant difference in latero-nasal width parameters between the groups (P < 0.05).

A comparison of the initial 3D model measurement values of both groups is presented in Table I. The initial parameters were found to show similarities between the groups (P > 0.05). The intra-group comparison of changes induced by RME is shown in Table II. There was a statistically significant increase observed in maxillary intercanine and intermolar distances and palatal area measurements in both groups (P < 0.05). The change in mandibular intercanine and intermolar width parameters was not statistically significant in either group (P > 0.05). A comparison of the differences between the pre-RME-treatment and post-RME-treatment is presented in Table III. No significant difference was found between the groups upon comparing the measurement changes on the 3D models.

Discussion

In the present prospective clinical study, normal-weight and obese-overweight individuals each with a transverse maxillary deficiency underwent an expansion procedure using a mini-screw-assisted RME appliance.

In a tooth-borne RME appliance, the supporting teeth may incline toward the buccal and, as a result, periodontal problems may arise.7,8 Similarly, the skeletal effect is limited in tooth-borne RME appliances. With the advent of mini-screws, mini-screw-assisted RME appliances have been designed to promote enhanced skeletal support and effect. Numerous studies have evaluated the dental and skeletal effects of tooth-borne and mini-screw-assisted RME appliances;11–13 however, no studies assessing the dental and skeletal effects of an RME in children with different BMI percentiles have been conducted.

Lim et al.14 reported that mini-screw-assisted RME without surgically assisted bone damage is an effective method for the treatment of a maxillary transverse deficiency in adolescents. In the present study, a mini-screw-assisted RME appliance was placed to create more skeletal change and enable expected post-treatment stability.

Obesity is recognised to have a negative effect on general health status over time. Childhood obesity may lead to metabolic and cardiovascular problems, gastrointestinal diseases, orthopaedic complications, and bone fractures.15–17 While there are several methods by which body mass might be evaluated, as the most reliable and practical method, the BMI percentile was used in the present study to assess the BMI of the participating children.18 The BMI percentile can be expressed as a percentage generated from a graphical or percentage calculator and specifically determined for any age or gender. Individuals below the fifth percentile are regarded as underweight; if the BMI falls between the fifth and eighty-fourth percentile, it reflects a normal-weight; if it falls between the eighty-fifth and ninety-fourth percentile, the individual is considered overweight; and individuals falling on the ninety-fifth percentile or above are regarded as obese.19

Obesity is the primary factor in the development of obstructive sleep apnoea (OSA).20 It is suggested that tooth-borne RME appliances can be used in the treatment of OSA in children.21 In recent years, mini-screw-assisted RME appliances have been widely used to achieve a greater skeletal effect.7 Hur et al.22 reported that mini-screw-assisted RME appliances could be an effective treatment alternative in the management of adults with moderate sleep apnoea by increasing the airway dimension and reducing resistance. In addition, Saloom et al.23 evaluated orthodontic movement in obese and normal-weight patients and reported that obese subjects needed less time to achieve tooth alignment compared with normal-weight patients; however, this difference was not statistically significant. Therefore, the present study investigated normal-weight and obese-overweight patients following expansion generated by a mini-screw-assisted RME appliance.

Numerous studies have been conducted to determine the effects of obesity on bone metabolism.4,24 Giuca et al.4 evaluated cervical vertebrae maturation by applying a carpal analysis of 50 children. It was concluded that obese children had higher mean values and significantly higher cervical vertebrae maturation scores when compared to normal-weight children. Similarly, following a study investigating the effects of childhood obesity on bone density and size, Leonard et al.20 stated that the vertebral bone densities and the whole-body frame sizes of obese children were greater than non-obese children. Although there are studies evaluating palatal suture maturation in adolescents and children by three-dimensional methods,25–28 no study concerned with palatal suture maturation in children or adolescents with different body mass indices has been identified.

Following a study in which different screw-turning protocols were applied, Perillo et al.29 stated that RME increased the distance between the maxillary molars. Chung and Font30 applied a conventional Haas-type RME appliance on 20 children whose mean age was 11.7 years and evaluated the effects on dental casts and on lateral and P-A cephalometric radiographs. Based on the cast measurements, an increase in maxillary intermolar and interpremolar widths was observed after the expansion procedure. There were further increases in nasal and maxillary widths based on P-A cephalometric measurements. In the present study, an increase was observed in intermolar and intercanine distances and palatal area measurements in both groups based on measurements conducted on the 3-D models. However, increases occurring in measurements performed on 3-D models did not reflect a statistically significant difference between the groups. A statistically significant increase was observed in latero-nasal and maxillary widths in the overweight-obese group based on measurements performed on the P-A cephalometric radiographs. Similarly while a statistically significant change occurred in the gonial and nasolabial angles in the obese-overweight group, based on lateral cephalometric films, a significant change was detected in the SN-GoMe, Wits, FMA, Z angle, total and lower anterior facial height parameters in the normal-weight group as a result of the mini-screw-assisted RME.

The present study had limitations. The number of patients decreased due to the specific clinical study conditions, co-operation problems, oral hygiene and periodontal issues. Future prospective clinical studies should be designed to incorporate larger sample sizes.

Conclusion

  • Mini-screw-assisted RME treatment significantly increased maxillary intercanine width, intermolar width and the palatal area in both groups. The increase in these measurements was not statistically significant between the groups.

  • An increase in latero-nasal and maxillary widths was observed in the overweight-obese group on P-A cephalometric radiographs. A significant difference in latero-nasal width was observed between the groups.

  • There was a statistically significant change in the gonial and nasolabial angles in the obese-overweight group. A significant change was observed in the ANB, SN-GoMe, Z angle, Wits appraisal, total anterior facial height and lower anterior facial height measurements in the normal-weight group. A significant difference was noted in the gonial and nasolabial angles in the overweight-obese group.

Conflict of Interest

The authors declare that there is no conflict of interest.

Acknowledgement

This study was supported by Ordu University Research Committee (A-1903).

References


  1. Buoncristiano M , Spinelli A , Williams J , Nardone P , Rito AI , García-Solano M . Childhood overweight and obesity in Europe: Changes from 2007 to 2017. Obes Rev 2021;10:e13226, doi: 10.1111/obr.13226. Epub ahead of print.
  2. Marcantonio CC , Nogueira AVB , Leguizamón NDP , de Molon RS , Lopes MES , Silva RCL . Effects of obesity on periodontal tissue remodeling during orthodontic movement. Am J Orthod Dentofacial Orthop 2021;159:480–490.
  3. Gordon LA , Miller SF , Caplin J , Galang-Boquiren MT , Alrayyes S , Nicholas CL . Childhood obesity may accelerate timing of human facial growth. Arch Oral Biol 2021;121:104964.
  4. Giuca MR , Pasini M , Tecco S , Marchetti E , Giannotti L , Marzo G . Skeletal maturation in obese patients. Am J Orthod Dentofacial Orthop 2012;142:774–779.
  5. da Silva Filho OG , Montes LA , Torelly LF . Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis. Am J Orthod Dentofacial Orthop 1995;107:268–275.
  6. Bala AK , Campbell PM , Tadlock LP , Schneiderman ED , Buschang PH . Short-term skeletal and dentoalveolar effects of overexpansion. Angle Orthod 2022;92:55–63.
  7. Annarumma F , Posadino M , De Mari A , Drago S , Aghazada H , Gravina GM . Skeletal and dental changes after maxillary expansion with a bone-borne appliance in young and late adolescent patients. Am J Orthod Dentofacial Orthop 2021;159:e363–e375.
  8. Lagravère MO , Carey J , Heo G , Toogood RW , Major PW . Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: a randomized clinical trial. Am J Orthod Dentofacial Orthop. 2010;137:304;e1-12; discussion 304-5.
  9. Koudstaal MJ , Wolvius EB , Schulten AJ , Hop WC , van der Wal KG . Stability, tipping and relapse of bone-borne versus tooth-borne surgically assisted rapid maxillary expansion; a prospective randomized patient trial. Int J Oral Maxillofac Surg 2009;38:308–315.
  10. Abu Arqub S , Mehta S , Iverson MG , Yadav S , Upadhyay M , Almuzian M . Does Mini Screw Assisted Rapid Palatal Expansion (MARPE) have an influence on airway and breathing in middle-aged children and adolescents? A systematic review. Int Orthod 2021;19:37–50.
  11. Kavand G , Lagravère M , Kula K , Stewart K , Ghoneima A . Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion. Angle Orthod 2019;89:566–574.
  12. Mosleh MI , Kaddah MA , Abd ElSayed FA , ElSayed HS . Comparison of transverse changes during maxillary expansion with 4-point bone-borne and tooth-borne maxillary expanders. Am J Orthod Dentofacial Orthop 2015;148:599–607.
  13. Khosravi M , Ugolini A , Miresmaeili A , Mirzaei H , Shahidi-Zandi V , Soheilifar S . Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review. Int Orthod. 2019;17:425–436.
  14. Lim HM , Park YC , Lee KJ , Kim KH , Choi YJ . Stability of dental, alveolar, and skeletal changes after miniscrew-assisted rapid palatal expansion. Korean J Orthod 2017;47:313–322.
  15. Burt Solorzano CM , McCartney CR . Obesity and the pubertal transition in girls and boys. Reproduction 2010;140:399–410.
  16. Han JC , Lawlor DA , Kimm SY . Childhood obesity. Lancet 2010;375:1737–1748.
  17. Consolaro A . Obesity and orthodontic treatment: is there any direct relationship? Dental Press J Orthod 2017;22:21–25.
  18. Wright KN . Influence of body mass index, gender, and Hispanic ethnicity on physical activity in urban children. J Spec Pediatr Nurs 2011;16:90–104.
  19. Maïano C , Hue O , Morin AJ , Moullec G . Prevalence of overweight and obesity among children and adolescents with intellectual disabilities: a systematic review and meta-analysis. Obes Rev. 2016;17:599–611.
  20. Carter R III , Watenpaugh DE . Obesity and obstructive sleep apnea: or is it OSA and obesity? Pathophysiology 2008;15:71–77.
  21. Katyal V , Pamula Y , Daynes CN , Martin J , Dreyer CW , Kennedy D . Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2013;144:860–871.
  22. Hur JS , Kim HH , Choi JY , Suh SH , Baek SH . Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid-structure interaction analysis. Korean J Orthod 2017;47:353–364.
  23. Saloom HF , Papageorgiou SN , Carpenter GH , Cobourne MT . Impact of obesity on orthodontic tooth movement in adolescents: a prospective clinical cohort study. J Dent Res 2017;96:547–554.
  24. Leonard MB , Shults J , Wilson BA , Tershakovec AM , Zemel BS . Obesity during childhood and adolescence augments bone mass and bone dimensions. Am J Clin Nutr 2004;80:514–523.
  25. Angelieri F , Cevidanes LH , Franchi L , Gonçalves JR , Benavides E , McNamara JA Jr . Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2013;144:759–769.
  26. Isfeld D , Flores-Mir C , Leon-Salazar V , Lagravère M . Evaluation of a novel palatal suture maturation classification as assessed by cone-beam computed tomography imaging of a pre- and postexpansion treatment cohort. Angle Orthod 2019;89:252–261.
  27. da Silva Filho OG , Lara TS , da Silva HC , Bertoz FA . Post expansion evaluation of the midpalatal suture in children submitted to rapid palatal expansion: a CT study. J Clin Pediatr Dent 2006;31:142–148.
  28. Jesus AS , Oliveira CB , Murata WH , Suzuki SS , Santos-Pinto AD . Would midpalatal suture characteristics help to predict the success rate of miniscrew-assisted rapid palatal expansion? Am J Orthod Dentofacial Orthop 2021;160:363–373.
  29. Perillo L , De Rosa A , Iaselli F , d’Apuzzo F , Grassia V , Cappabianca S . Comparison between rapid and mixed maxillary expansion through an assessment of dento-skeletal effects on posteroanterior cephalometry. Prog Orthod 2014;15:46.
  30. Chung CH , Font B . Skeletal and dental changes in the sagittal, vertical, and transverse dimensions after rapid palatal expansion. Am J Orthod Dentofacial Orthop 2004;126:569–575.
XML PDF Share

FIGURES & TABLES

Figure 1.

Mini-screw-assisted rapid maxillary expansion.

Full Size   |   Slide (.pptx)

Figure 2.

(1) SNA, (2) SNB, (3) ANB, (4) gonial angle, (5) SN/GoMe, (6) FMA, (7) FMIA, (8) IMPA, (9) U1/SN, (10) nasolabial angle, (11) Z angle.

Full Size   |   Slide (.pptx)

Figure 3.

(1) Wits appraisal, (2) total anterior facial height, (3) lower anterior facial height, (4) U6/PP, (5) L6/MP.

Full Size   |   Slide (.pptx)

Figure 4.

(1) Bizygomatic width, (2) lateronasal width, (3) maxillomandibulare width, (4) maxillare width.

Full Size   |   Slide (.pptx)

Figure 5.

(1) Intercanine width, (2) palatal area, (3) intermolar width.

Full Size   |   Slide (.pptx)

Figure 6.

(1) Intercanine width, (2) intermolar width.

Full Size   |   Slide (.pptx)

REFERENCES

  1. Buoncristiano M , Spinelli A , Williams J , Nardone P , Rito AI , García-Solano M . Childhood overweight and obesity in Europe: Changes from 2007 to 2017. Obes Rev 2021;10:e13226, doi: 10.1111/obr.13226. Epub ahead of print.
  2. Marcantonio CC , Nogueira AVB , Leguizamón NDP , de Molon RS , Lopes MES , Silva RCL . Effects of obesity on periodontal tissue remodeling during orthodontic movement. Am J Orthod Dentofacial Orthop 2021;159:480–490.
  3. Gordon LA , Miller SF , Caplin J , Galang-Boquiren MT , Alrayyes S , Nicholas CL . Childhood obesity may accelerate timing of human facial growth. Arch Oral Biol 2021;121:104964.
  4. Giuca MR , Pasini M , Tecco S , Marchetti E , Giannotti L , Marzo G . Skeletal maturation in obese patients. Am J Orthod Dentofacial Orthop 2012;142:774–779.
  5. da Silva Filho OG , Montes LA , Torelly LF . Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroanterior cephalometric analysis. Am J Orthod Dentofacial Orthop 1995;107:268–275.
  6. Bala AK , Campbell PM , Tadlock LP , Schneiderman ED , Buschang PH . Short-term skeletal and dentoalveolar effects of overexpansion. Angle Orthod 2022;92:55–63.
  7. Annarumma F , Posadino M , De Mari A , Drago S , Aghazada H , Gravina GM . Skeletal and dental changes after maxillary expansion with a bone-borne appliance in young and late adolescent patients. Am J Orthod Dentofacial Orthop 2021;159:e363–e375.
  8. Lagravère MO , Carey J , Heo G , Toogood RW , Major PW . Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: a randomized clinical trial. Am J Orthod Dentofacial Orthop. 2010;137:304;e1-12; discussion 304-5.
  9. Koudstaal MJ , Wolvius EB , Schulten AJ , Hop WC , van der Wal KG . Stability, tipping and relapse of bone-borne versus tooth-borne surgically assisted rapid maxillary expansion; a prospective randomized patient trial. Int J Oral Maxillofac Surg 2009;38:308–315.
  10. Abu Arqub S , Mehta S , Iverson MG , Yadav S , Upadhyay M , Almuzian M . Does Mini Screw Assisted Rapid Palatal Expansion (MARPE) have an influence on airway and breathing in middle-aged children and adolescents? A systematic review. Int Orthod 2021;19:37–50.
  11. Kavand G , Lagravère M , Kula K , Stewart K , Ghoneima A . Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion. Angle Orthod 2019;89:566–574.
  12. Mosleh MI , Kaddah MA , Abd ElSayed FA , ElSayed HS . Comparison of transverse changes during maxillary expansion with 4-point bone-borne and tooth-borne maxillary expanders. Am J Orthod Dentofacial Orthop 2015;148:599–607.
  13. Khosravi M , Ugolini A , Miresmaeili A , Mirzaei H , Shahidi-Zandi V , Soheilifar S . Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review. Int Orthod. 2019;17:425–436.
  14. Lim HM , Park YC , Lee KJ , Kim KH , Choi YJ . Stability of dental, alveolar, and skeletal changes after miniscrew-assisted rapid palatal expansion. Korean J Orthod 2017;47:313–322.
  15. Burt Solorzano CM , McCartney CR . Obesity and the pubertal transition in girls and boys. Reproduction 2010;140:399–410.
  16. Han JC , Lawlor DA , Kimm SY . Childhood obesity. Lancet 2010;375:1737–1748.
  17. Consolaro A . Obesity and orthodontic treatment: is there any direct relationship? Dental Press J Orthod 2017;22:21–25.
  18. Wright KN . Influence of body mass index, gender, and Hispanic ethnicity on physical activity in urban children. J Spec Pediatr Nurs 2011;16:90–104.
  19. Maïano C , Hue O , Morin AJ , Moullec G . Prevalence of overweight and obesity among children and adolescents with intellectual disabilities: a systematic review and meta-analysis. Obes Rev. 2016;17:599–611.
  20. Carter R III , Watenpaugh DE . Obesity and obstructive sleep apnea: or is it OSA and obesity? Pathophysiology 2008;15:71–77.
  21. Katyal V , Pamula Y , Daynes CN , Martin J , Dreyer CW , Kennedy D . Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2013;144:860–871.
  22. Hur JS , Kim HH , Choi JY , Suh SH , Baek SH . Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid-structure interaction analysis. Korean J Orthod 2017;47:353–364.
  23. Saloom HF , Papageorgiou SN , Carpenter GH , Cobourne MT . Impact of obesity on orthodontic tooth movement in adolescents: a prospective clinical cohort study. J Dent Res 2017;96:547–554.
  24. Leonard MB , Shults J , Wilson BA , Tershakovec AM , Zemel BS . Obesity during childhood and adolescence augments bone mass and bone dimensions. Am J Clin Nutr 2004;80:514–523.
  25. Angelieri F , Cevidanes LH , Franchi L , Gonçalves JR , Benavides E , McNamara JA Jr . Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2013;144:759–769.
  26. Isfeld D , Flores-Mir C , Leon-Salazar V , Lagravère M . Evaluation of a novel palatal suture maturation classification as assessed by cone-beam computed tomography imaging of a pre- and postexpansion treatment cohort. Angle Orthod 2019;89:252–261.
  27. da Silva Filho OG , Lara TS , da Silva HC , Bertoz FA . Post expansion evaluation of the midpalatal suture in children submitted to rapid palatal expansion: a CT study. J Clin Pediatr Dent 2006;31:142–148.
  28. Jesus AS , Oliveira CB , Murata WH , Suzuki SS , Santos-Pinto AD . Would midpalatal suture characteristics help to predict the success rate of miniscrew-assisted rapid palatal expansion? Am J Orthod Dentofacial Orthop 2021;160:363–373.
  29. Perillo L , De Rosa A , Iaselli F , d’Apuzzo F , Grassia V , Cappabianca S . Comparison between rapid and mixed maxillary expansion through an assessment of dento-skeletal effects on posteroanterior cephalometry. Prog Orthod 2014;15:46.
  30. Chung CH , Font B . Skeletal and dental changes in the sagittal, vertical, and transverse dimensions after rapid palatal expansion. Am J Orthod Dentofacial Orthop 2004;126:569–575.

EXTRA FILES

COMMENTS