Microimplant Assisted Rapid Palatal Expansion: A Comprehensive Review

Maxillary transverse deficiency routinely requires expansion of the palate. In prepubertal patients, Rapid Maxillary Expansion (RME) is a reliable treatment modality. However, in skeletally mature patients due to progressively interdigitated mid palatal suture, decreased elasticity of bone and increased stiffness of the osseous articulations of the maxilla with the adjoining bones, palatal expansion becomes challenging. Patients are frequently suggested to opt for more invasive procedures, like the Surgically Assisted Rapid Palatal Expansion (SARPE). The quest for minimally invasive expansion appliances with pure orthopaedic movement led researchers to incorporate mini-implants with conventional RME. Microimplant Assisted Rapid Palatal Expansion (MARPE) maximises skeletal expansion and minimises dentoalveolar undesirable effects and obviates the need for orthognathic surgery. This comprehensive review aims to discuss MARPE as an effective, non surgical, minimally invasive treatment modality for skeletally mature patients with maxillary transverse insufficiency. Furthermore, various designs of MARPE with different placement sites, lengths, and numbers of miniscrews along with the latest technological advancements to improve diagnosis and treatment planning using CBCT and intraoral scan, as well as the use of Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology to custom fabricate three dimensional (3D) miniscrew insertion surgical guide, 3D laser-printed metallic mini-implant to enhance implant placement accuracy and comfort were discussed along with the clinical significance and limitations of the MARPE. Maxillary Skeletal Expander (MSE) is a unique lineage of MARPE when combined with facemask results in distraction osteogenesis like movement of midface and forms a promising basis for non surgical orthopaedic treatment modality for skeletal class III mature patients. Bone-anchored maxillary expansion appliances provide better vertical control, especially beneficial for hyperdivergent skeletal pattern patients. MARPE significantly increases transverse widths of the nasal floor, nasopharyngeal volume and significantly lowers mean nasal airway resistance thereby facilitating nasal breathing. MARPE results in greater orthopaedic expansion and safety, with fewer undesirable effects and high success rates.

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CAD/CAM Ceramic Restorative Materials for Natural Teeth

Journal of Dental Research ◽

10.1177/0022034518779759 ◽

2018 ◽

Vol 97 (10) ◽

pp. 1082-1091 ◽

Cited By ~ 32

Author(s):

F.A. Spitznagel ◽

J. Boldt ◽

P.C. Gierthmuehlen

Keyword(s):

Minimally Invasive ◽

Computer Aided Design ◽

Clinical Performance ◽

Treatment Options ◽

Glass Ceramics ◽

Invasive Treatment ◽

Fixed Prosthodontics ◽

Computer Aided ◽

Cad Cam

Advances in computer-aided design (CAD) / computer-aided manufacturing (CAM) technologies and their ease of application enabled the development of novel treatment concepts for modern prosthodontics. This recent paradigm shift in fixed prosthodontics from traditional to minimally invasive treatment approaches is evidenced by the clinical long-term success of bonded CAD/CAM glass-ceramic restorations. Today, defect-oriented restorations, such as inlays, onlays, and posterior crowns, are predominately fabricated from glass-ceramics in monolithic application. The variety of CAD/CAM ceramic restorative systems is constantly evolving to meet the increased demands for highly aesthetic, biocompatible, and long-lasting restorations. Recently introduced polymer-infiltrated ceramic network CAD/CAM blocks add innovative treatment options in CAD/CAM chairside 1-visit restorations. The material-specific high-edge stability enables the CAD/CAM machinability of thin restoration margins. Full-contour zirconia restorations are constantly gaining market share at the expense of bilayered systems. Advancements in material science and bonding protocols foster the development of novel material combinations or fabrication techniques of proven high-strength zirconia ceramics. CAD/CAM applications offer a standardized manufacturing process resulting in a reliable, predictable, and economic workflow for individual and complex teeth-supported restorations. More evidence from long-term clinical studies is needed to verify the clinical performance of monolithic polymer-infiltrated ceramic network and zirconia teeth-supported minimally invasive and extensive restorations.

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RAPID PALATAL EXPANSION AND ITS FEATURES

ASJ. ◽

10.31618/asj.2707-9864.2020.2.40.23 ◽

2020 ◽

Vol 2 (40) ◽

pp. 20-22

Author(s):

A.K. Al Dzhafari ◽

S.A. Ulyanovskaya

Keyword(s):

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Maxillofacial Region ◽

Posterior Teeth ◽

Anatomical Features ◽

Palatal Expansion ◽

Rapid Palatal Expansion ◽

Congenital Deformities ◽

Upper Jaw ◽

Mid Palatal Suture

Rapid Maxillary expansion or palatal expansion as it is sometimes called, occupies unique niche in dentofacial therapy. Rapid Maxillary expansion (RME) is a skeletal type of expansion that involves the separation of the mid-palatal suture and movement of the maxillary shelves away from each other. RME effects the maxillary complex, palatal vaults, maxillary anterior and posterior teeth, adjacent periodontal structures to bring about an expansion in the maxillary arch. Morphogenesis and anatomical features of the upper jaw determine the choice of the method of rapid palatal expansion with narrowing of the upper dentition, as an effective method for eliminating congenital deformities of the maxillofacial region. The majority of dental transverse measurements changed significantly as a result of RME. The maturity of the maxillofacial structures determines the timing and degree of success of rapid palatal dilatation treatment.

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Condylar Changes in Children with Posterior Crossbite after Maxillary Expansion: Tridimensional Evaluation

Children ◽

10.3390/children8010038 ◽

2021 ◽

Vol 8 (1) ◽

pp. 38

Author(s):

Rosamaria Fastuca ◽

Helga Turiaco ◽

Fausto Assandri ◽

Piero A. Zecca ◽

Luca Levrini ◽

...

Keyword(s):

Rapid Maxillary Expansion ◽

3D Analysis ◽

Maxillary Expansion ◽

3D Slicer ◽

Palatal Expansion ◽

Posterior Crossbite ◽

Rapid Palatal Expansion ◽

Before And After ◽

Condylar Position ◽

Caucasian Patients

(1) Background: To investigate condylar position in subjects with functional posterior crossbite comparing findings before and after rapid maxillary expansion (RME) treatment through 3D analysis; (2) Methods: Thirty-two Caucasian patients (14 males, mean age 8 y 8 m ± 1 y 2 m; 18 females mean age 8 y 2 m ± 1 y 4 m) with functional posterior crossbite (FPXB) diagnosis underwent rapid palatal expansion with a Haas appliance banded on second deciduous upper molars. Patients’ underwent CBCT scans before rapid palatal expansion (T0) and after 12 months (T1). The images were processed through 3D slicer software; (3) Results: The condylar position changes between T1 and T0 among the crossbite and non-crossbite sides were not statistically significant, except for the transversal axis. At T1, the condyles moved forward (y axis) and laterally (x axis), they also moved downward (z axis) but not significantly; (4) Conclusions: Condilar position in growing patients with functional posterior crossbite did not change significantly after rapid maxillary expansion.

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Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis

European Journal of Orthodontics ◽

10.1093/ejo/cjab005 ◽

2021 ◽

Author(s):

Aldin Kapetanović ◽

Christina I Theodorou ◽

Stefaan J Bergé ◽

Jan G J H Schols ◽

Tong Xi

Keyword(s):

Systematic Review ◽

Success Rate ◽

Observational Studies ◽

Risk Of Bias ◽

Late Adolescents ◽

Maxillary Expansion ◽

Palatal Expansion ◽

Rapid Palatal Expansion ◽

Adolescents And Adults ◽

Maxillary Deficiency

Summary Background Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy. Objectives This systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects. Search methods Seven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020. Selection criteria Randomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes. Data collection and analysis Inclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality. Results Eight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%–96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm–3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm–7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days. Limitations One of the main drawbacks was the lack of high-quality prospective studies in the literature. Conclusions and implications MARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended. Registration PROSPERO (CRD42020176618). Funding No grants or any other support funding were received.

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Current Concepts of Minimally Invasive Treatment Options for Plantar Fasciitis: a Comprehensive Review

Current Pain and Headache Reports ◽

10.1007/s11916-020-00883-7 ◽

2020 ◽

Vol 24 (9) ◽

Author(s):

Morgan Hasegawa ◽

Ivan Urits ◽

Vwaire Orhurhu ◽

Mariam Salisu Orhurhu ◽

Joseph Brinkman ◽

...

Keyword(s):

Minimally Invasive ◽

Plantar Fasciitis ◽

Treatment Options ◽

Minimally Invasive Treatment ◽

Invasive Treatment ◽

Comprehensive Review

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MODERN PERSPECTIVES ON RAPID PALATAL EXPANSION

International Journal of Advanced Research ◽

10.21474/ijar01/12864 ◽

2021 ◽

Vol 9 (5) ◽

pp. 497-500

Author(s):

Kinnari Markana ◽

Keyword(s):

Transverse Dimension ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Negative Effects ◽

Palatal Expansion ◽

Beneficial Effects ◽

Rapid Palatal Expansion ◽

Mini Implants ◽

Maxillary Deficiency ◽

Skeletal Expansion

Maxillary deficiency in the transverse dimension is a common problem in children. The conventional management of such malocclusion is with conventional rapid maxillary expansion. The beneficial effects of such an orthodontic therapy are explained in detail in the literature. But there are also negative effects of conventional rapid maxillary expansion. Thus, the improvements in the methods of expansion has led to discovery of miniscrew assisted rapid palatal expansion. The miniscrew assisted rapid palatal expansion are supported by mini implants and thus enable better skeletal expansion of maxilla. This article will discuss the favourable effects, negative effects, and clinical uses of conventional and miniscrew assisted rapid palatal expansion.

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