Littérature scientifique sur le sujet « Orthopedic effects, midpalatal suture »

Introduction. Microimplant-assisted rapid palatal expansion (MARPE) has been considered an alternative to avoid extensive surgical procedures. In order to obtain skeletal results of MARPE, force should be enough to overcome areas of resistance and the first one that is required to be disrupted is the midpalatal suture, which becomes increasingly interdigitated after adolescence. Objective. The present study aimed at providing a novel approach using a minimally invasive method called corticopuncture (CP) in association with MARPE illustrated by a case report of a 35-year-old Brazilian female Caucasian patient presenting maxillary transverse deficiency. Method. Treatment plan started with an orthopedic correction of the transverse problem using a MARPE device. After many unsuccessful attempts to activate MARPE, corticopunctures were performed along the midpalatal suture. CP procedure at the midpalatal suture included 8 perforations (2 mm apart), performed after previous predrilling followed by miniscrew insertion (5 mm thread length and 1.8 mm diameter). Results. After CP and new activation protocol, the opening of the midpalatal suture was observed by CBCT images, showing skeletal results, suture split of 3.14 mm (premolar area) and 2.06 (molar area), an increase of 4.3 mm (premolar) and 3.03 mm (molar) in basal bone width, 4.43 mm (premolar) and 3.1 mm (molar) in cortical bone width, and minimal dental effects (mean of 1.2° of tooth tipping). Conclusion. The combination of MARPE and corticopuncture method was proved to be a nonsurgical treatment option to correct maxillary transverse deficiency in an adult patient. CP was able to weaken suture interdigitation thus facilitating the split.

Objective: To evaluate the Microimplant-assisted Rapid Palatal Expansion (MARPE), considered an alternative to surgical interventions for disjunction of the midpalatal suture in adolescent patients and young adults with maxillary transverse deficiency. The stage of ossification of the midpalatal suture, bone quality and adequate activation protocols are factors that can influence the quantity and quality of the orthopedic separation. Methodology: This paper demonstrates the application of MARPE in an unfavorable case report, of an adult patient with total crossbite, in an advanced stage of fusion of the palatine and maxillary processes, with poverty in the posterior bone volume, in comparison with the same therapy in an adolescent at an earlier stage of sutural maturation. In both cases, after tomographic examinations and oral scanning, the installations and recommended activation protocol were performed. These were not sufficient in the case of the adult patient, and generated side effects that, to be overcome, required changes in activations and additional maneuvers. Results: The application of MARPE may require clinical versatility to adopt differentiated protocols in relation to chronological age, bone thickness and sutural ossification stage. Conclusion: In the end, new computer tomography scans and a clinical examination showed satisfactory results in both patients. In the unfavorable case, the opening of the midpalatal suture occurred at more modest levels, but it was sufficient to correct the posterior crossbite.

ABSTRACT Objectives To evaluate the clinical effectiveness of adjunctive interventions in individuals undergoing rapid maxillary expansion (RME). Materials and Methods MEDLINE, Web of Science, Cochrane, Scopus, LILACS, and Google Scholar were searched without restrictions up to June 2020. Trials involving participants undergoing orthopedic or surgical RME, along with adjunctive interventions, were included. Risk-of-bias assessments were performed using the Cochrane tool for randomized trials-2. The certainty level of evidence was assessed through the Grading of Recommendations Assessment, Development and Evaluation tool. Results Six randomized clinical trials, with low to high risk of bias, were included. Low certainty of the evidence suggested that low-level laser facilitated opening of the midpalatal suture during the active phase of RME. Likewise, moderate certainty demonstrated that low-level laser accelerated the healing process of the suture during the retention phase. The clinical impact of this outcome, that is, stability and retention time, was not evaluated. Very low evidence indicated that osteoperforations along the midpalatal suture increased maxillary transverse skeletal gains in young adults undergoing RME. Low evidence suggested that platelet-rich plasma therapy did not minimize the vertical and thickness bone loss after RME in the short term. Conclusions Based on currently available information, the use of low-level laser associated with maxillary expansion seems to provide a more efficient suture opening and bone healing. Limited evidence suggests that osteoperforations improve the skeletal effects of RME in non-growing individuals. There are no adjunctive interventions capable of reducing the periodontal side effects of RME.

ABSTRACT The midpalatal suture has bone margins with thick connective tissue interposed between them, and it does not represent the fusion of maxillary palatal processes only, but also the fusion of palatal processes of the jaws and horizontal osseous laminae of palatal bones. Changing it implies affecting neighboring areas. It has got three segments that should be considered by all clinical analyses, whether therapeutic or experimental: the anterior segment (before the incisive foramen, or intermaxillary segment), the middle segment (from the incisive foramen to the suture transversal to the palatal bone ) and the posterior segment (after the suture transversal to the palatal bone ). Rapid palatal expansion might be recommended for patients at the final pubertal growth stage, in addition to adult patients with maxillary constriction. It represents a treatment solution that can potentially avoid surgical intervention. When performed in association with rapid palatal expanders, it might enhance the skeletal effects of the latter. Of the various designs of expansion appliances, MARPE (miniscrew-assisted rapid palatal expander) has been modified in order to allow its operational advantages and outcomes to become familiar in the clinical practice.

The aim of this retrospective study was to evaluate the correlation between the midpalatal suture maturation and skeletal maturation in growing children aged 7 - 15 years and predict the maturational stages of the midpalatal suture corresponding to skeletal maturity assessed by the skeletal maturation indicators (SMI) and middle phalanx of the third finger (MP3) stages. The group of this retrospective study was consisted of randomly selected 132 male and 135 female in age from 7 - 15 years. The maturation of the midpalatal suture was evaluated by using images from cone-beam computed tomography (CBCT) while the skeletal age was assessed by hand-wrist radiography. CBCT images and hand-wrist radiographs used in this study were obtained from all subjects for orthodontic diagnosis before orthodontic treatment. The maturational stages of the midpalatal suture showed strong correlations with both SMI and MP3 stages. The correlation between the midpalatal suture maturation and SMI (Spearman’s correlation coefficient, ϒ_S = 0.905, <i>p</i> < 0.05) was slightly greater than that of MP3 stages (ϒ_S = 0.830, <i>p</i> < 0.05). There was a positive significant correlation between the midpalatal suture maturation and chronological age (ϒ_S = 0.868,<i>p</i> < 0.05). CBCT for evaluation of the midpalatal suture maturational stages may be unnecessary in every pediatric patients because SMI and MP3 stages were both replaceable useful methods for assessing maturation of the midpalatal suture before orthopedic treatment. In this retrospective study, the diagnostic reliability of the SMI method for estimating midpalatal suture maturation showed better reliability than the MP3 method.

Changes in the midpalatal suture and the alterations in intercanine and intermolar widths with the use of the quad-helix appliance were evaluated. Study casts and occlusal radiographs from 10 patients with a mean age of 4 years and 10 months (SD 11 months) were analyzed. A statistically significant palatal suture widening was observed in all cases. The proportion of dental tipping accomplished with the treatment was greater than opening of the suture.

Abstract Objective: To assess the scientific evidence that rapid maxillary expansion (RME) causes Adverse Effects on the midpalatal suture, vertical dimension, dental and periodontal structures in growing subjects. Materials and Methods Electronic databases were searched for articles dated through December 2011. The quality of the studies was ranked on a 13-point scale in which 1 was the low end of the scale and 13 was the high end. Results: Thirty relevant articles were identified. The amount of midpalatal suture opening ranged from 1.6 to 4.3 mm in the anterior region and from 1.2 to 4.4 mm in the posterior region. At the end of the active phase, RME resulted in slight inferior movement of the maxilla (SN-PNS +0.9 mm; SN-ANS +1.6 mm), increased tipping of anchored teeth from 3.4° to 9.2° and bending of the alveolar bone from 5.1° to 11.3°. In the long term, RME did not modify the facial growth patterns, and no significant changes on dentoalveolar structures were observed. Of the 30 studies, 2 were medium-high quality, 8 were medium quality, and 20 were low quality. Conclusions: RME always opened the midpalatal suture in growing subjects. The vertical changes were small and transitory. In the long-term evaluation, an uprighting of anchored teeth was observed and periodontal structures were not compromised.

INTRODUCTION: With the advent of cone beam computed tomography (CBCT), it is now possible to quantitatively evaluate the effects of rapid maxillary expansion (RME) on the entire maxillary complex in growing patients. OBJECTIVE: The purpose of this study is to use three-dimensional images to evaluate the displacement that occurs at the circummaxillary sutures (frontonasal, zygomaticomaxillary, intermaxillary, midpalatal, and transpalatal sutures) following rapid maxillary expansion in growing children. METHODS: The CBCT scans of 25 consecutively treated RME patients (10 male, 15 female) with mean age of 12.3 ± 2.6 years, were examined before expansion and immediately following the last activation of the expansion appliance. RESULTS: Statistically significant (P < 0.05) amounts of separation were found for the displacement of the bones of the frontonasal suture, the intermaxillary suture, the zygomaticomaxillary sutures, and the midpalatal suture. The change in angulation of the maxillary first molars due to RME was also statistically significant. There was no statistically significant displacement of the transpalatal suture. CONCLUSIONS: Rapid maxillary expansion results in significant displacement of the bones of circummaxillary sutures in growing children.

ABSTRACT Objective: To evaluate the effects of rapid maxillary expansion (RME) on the vocal quality, maxillary central incisors, midpalatal suture, and nasal cavity in patients with maxillary crossbite. Materials and Methods: Coronal CT scans of 30 subjects (14 boys, 16 girls; mean age, 12.01 ± 0.75) were taken before RME (T0), and at the end of the expansion phase (T1). Voice samples of all patients were recorded with a high-quality condenser microphone (RODE NT2-A) on a desktop computer at T0 and T1. Statistical analyses were performed using a paired-sample t-test. The degree of association between the changes in the voice parameters and nasal width was assessed with Pearson's correlation. Results: RME treatment produced a significant increase in the transverse dimensions of the midpalatal suture and nasal cavity between T0 and T1 (P &lt; .05). The maximum F0 and jitter (%) results were shown to decrease statistically significantly from T0 to T1 (P &lt; .001 and P = .042, respectively). Between T0 and T1, shimmer (%) and shimmer (dB) exhibited statistically significant increases (P = .037 and P = .019, respectively). Conclusions: After RME therapy, voice quality differences were found to be associated with increases in nasal width.

ABSTRACT Objective: To examine the effects of a soft diet and a low-calcium diet on the craniofacial growth and bone architectures of the maxilla and mandible. Materials and Methods: Male rats (n = 20, 3 weeks old) were divided into four groups. Ten rats were given a normal-calcium diet, and the other rats were given a low-calcium diet. Each group was then divided into two subgroups, which were fed a hard or a soft diet. After 4 weeks, craniofacial growth and architecture in maxillary and mandibular bone were analyzed using cephalometry, micro-computed tomography, and histopathology. Results: The low-calcium diet had no effect on serum calcium levels. The low-calcium diet had the greatest effect on craniofacial bone growth, while the soft diet affected the growth of several bone sites that are attached to the masseter muscle. A low-calcium diet resulted in the deterioration of the connectivity of the trabeculae in the furcation region of the maxillary and mandibular first molar, while a soft diet resulted in the diffuse disappearance of trabeculae in the central part of the furcation regions. In the midpalatal suture, a low-calcium diet resulted in inhibition of cartilaginous ossification, although the midpalatal suture had a normal cartilaginous structure. A soft diet resulted in narrower cartilage cell layers in the midpalatal suture. Conclusions: We demonstrated that a low-calcium diet and a soft diet resulted in a deterioration of bone structures in both the maxilla and in the mandible; however, the mechanisms underlying these effects differed between diets.

Introduction The aim of the present study is to evaluate the skeletal modifications induced by maxillary expansion supported by palatal micro-implants and localized osteotomies produced with minimally invasive surgical technique in young-adult and adult patients. In the present investigation, osteotomies had a lower extension than the ones used in conventional surgically assisted rapid palatal expansion (SARPE), to adopt a minimally invasive surgical technique that can be performed with greater comfort for the patient and less post-operative sequelae. More in detail, the localized osteotomies were executed only in the anterior part of the midpalatal suture and bilaterally at the basis of the zygomatic process of the maxilla without involvement of the piriform rim. These areas represent a great resistance to the lateral maxillary movement. Furthermore, they are of simple surgical access and don’t present important arterial plexuses. Patients requiring micro-implant supported maxillary expansion and/or SARPE routinely undergo a pre-treatment cone-beam computed tomography (CBCT) of the skull, to plan the surgical operation and, one month after treatment a secondary CBCT for a surgical and orthodontic control. CBCT is a low radiation tomography, extensively used in maxillofacial surgery and in dentistry. For the implementation of this study, that aims at evaluating the efficacy of micro-implant-supported maxillary expansion in combination with localized osteotomies, only radiologic exams that are anyway needed for the planning and post-treatment evaluation were used. Aim The aim of the present study is to evaluate the advantages introduced in the treatment of maxillary constriction by the therapy with micro-implant supported Maxillary Skeletal Expander (MSE) and localized osteotomies in young-adult and adult patients. The main objective is to evaluate the efficacy of the technique, by measuring the movement of skeletal landmarks in the midface, particularly on the maxillary and zygomatic bones, and on the lateral wall of the nose, by comparing the pre-treatment and post-treatment CBCT. For this particular technique, a new methodology for digital planning of position of MSE and miniscrews on patient CBCT was developed. Furthermore, incorporation of 2 additional miniscrews to the original MSE design, which conventionally features only 4 miniscrews, was developed with the aid of computer aided design – computer aided manufactured (CAD-CAM) technology. Methods The study presented the following steps: ▪ Development of a digital planning methodology for positioning the miniscrews and MSE appliance on pre-treatment CBCT ▪ Development of a CAD-CAM methodology for incorporating 2 additional miniscrews to the original MSE design with 4 miniscrews ▪ Selection of patients with age above 17 years, without congenital craniofacial syndromes, who require intervention of maxillary skeletal expansion ▪ Acquisition of initial CBCT with 17 x 13.5 cm field of view (FOV) ▪ Intervention of maxillary expansion supported by palatal micro-implants and localized osteotomies executed with minimally invasive surgical technique ▪ One month after treatment, acquisition of post-treatment CBCT with 17 x 13.5 cm FOV ▪ Analysis of skeletal modifications in the midface (maxillary bone, sphenoid bone, zygomatic arch, nasal cavity, etc.), by comparing the pre- and post- treatment CBCT with a 3D software (OnDemand software by Cybermed) Results The new methodology allowed the digital planning of MSE and miniscrews positioning on patients’ CBCTs, and the incorporation of two additional miniscrews to the original MSE design through CAD-CAM technology. In the clinical trial, a total of four patients had an average age of 27.6 years (range 22.1 – 39.9 years). MSE appliance was activated by an average of 6.0 mm and generated a parallel split of the midpalatal suture of 3.4 mm, 3.0 mm and 3.6 mm at anterior nasal spine (ANS), nasopalatine foramen (NPF) and posterior nasal spine (PNS), respectively. Skeletal modifications were found in all CBCT sections evaluated in the study (axial palatal, upper nasal, coronal zygomatic, axial zygomatic), indicating that all midfacial bones are affected by maxillary expansion with MSE and localized osteotomies. Particularly, skeletal changes were noticed also in CBCT sections above the lateral maxillary osteotomies (LMOs), in the maxilla, zygomatic bone, zygomatic arches, and nasal cavity. In the upper nasal section (UNS) the maxilla was laterally displaced by 2.4 mm and 0.9 mm, at its anterior and posterior extremities, respectively. The frontozygomatic angle (FZA) increased by 1.9° (average of right and left side), while the lower interzygomatic distance increased by 2.9 mm, indicating a rotation of the zygomatic bone in a lateral direction. The zygomatic arch was affected by bone bending phenomena and was deflected in an outward direction, with increase in the anterior intermaxillary distance by 1.7 mm and in the posterior inter-zygomatic distance by 1.6 mm. The nasal width (NW) parameter increased by 2.9 mm with treatment: this anatomical finding is the basis for a potential improvement in nasal breathing for patients suffering from increased nasal airway resistance. The cited modifications in skeletal structures above lateral maxillary osteotomies (LMOs) are most likely due to the fact that LMOs didn’t involve the piriform rim of the maxilla, and this point needs further investigations. Regarding dentoalveolar modifications, the inter-molar distance increased by 7.4 mm, and molars underwent a small dentoalveolar tipping in a buccal direction by 1.1° (average of right and left side), as evidenced by the change in molar basal bone angle (MBBA). No intra-operatory hemorrhage nor post-operatory bleeding was reported in treated patients, probably due to the lack of pterygopalatine suture surgical disjunction. A limitation of the study is its small sample size, represented by 4 patients. A larger number of patients is required to confirm the above results.

Introduction Whole body high-frequency low-magnitude vibration (HFLMV) is routinely used in the medical field to improve bone quality in children. For this treatment, vibration is induced during a period when growth of the midpalatal suture is heavily influenced by the external environment. The midpalatal suture acts as a growth site responding to external signals stimulating deposition of bone on the sutural edges, facilitating transverse maxillary growth. Any additional mechanical strain such as HFLMV could modify the rate of bone remodelling at the interface of the two maxillary bones and affect natural growth. Objectives To evaluate the effects of HFLMV on the volume of the midpalatal suture (MPS) of rats. Materials and methods This study consisted of forty-two, five-week-old Fisher Strain male rats which were previously used in a study investigating the effects of vibration on hypofunctional teeth. The rats were randomly allocated into Vibration and Non-vibration groups. In the vibration groups, HFLMV was induced through whole body vibration platforms. The rats were kept in their cages and placed two at a time on the vibrating platform set at a magnitude of 0.3g and frequency of 30Hz. This stimulus was applied for 20 minutes per day, five days per week for a total of 30 days. The MPS was analysed as two separate volumes of interest in order to avoid the regions complicated by the pre-maxillomaxillary and palatomaxillary sutures. Three-dimensional micro-computed tomography (micro-CT) was used to quantify the volumes of the MPS. The measured volumes of the mid-palatal suture were adjusted by the length of the rat heads and statistical analysis was conducted. Results There was no statistically significant difference in the volumes of the MPS in any region between the Vibration and Non-vibration groups. Conclusion The findings of this 30-day animal study indicate that HFLMV applied through whole body vibration platform does not affect the volume of the MPS of rats.

碩士
長庚大學
顱顏口腔醫學研究所
106
Purpose: The purpose of this study was to illustrate the indicating factors correlated to the amount of maxillary protraction in pubertal patients with maxillary hypoplasia. Additionally, this study also presented a three dimensional (3D) surface distance difference method for linear comparison in 3D skull models. Materials and Methods: A total of 54 pubertal subjects who were treated with 7 weeks of alternated rapid maxillary expansion and constriction protocol (Alt-RAMEC); maxillary protraction were included and classified into 20, 14, 20 patients of unilateral complete cleft lip and palate (UCLP), bilateral complete cleft lip and palate (BCLP) and non-cleft Class-III-group, respectively. The pretreatment (T0) and after protraction (T1) cone-beam computed tomography (CBCT) were taken. The midpalatal suture patency index (MSPI, suture-length/bone-length) was examined at four levels of maxilla on the axial sections of CBCT images at T0. The amount of maxillary protraction (AMP) around A-point, canine root tip, and piriform-aperture were measured. The AMP was compared among groups by one-way ANOVA, and the correlation of MSPI and AMP was tested by Pearson correlation analysis. Results: The AMP was not significantly different among groups (p>0.05). The AMP significantly correlated to MSPI at the coronal third level but not the basal bone level of the UCLP- (r= 0.78, p < 0.01), BCLP- (r =0.85, p <0.001), and non-cleft Class-III- (r =0.71, p <0.001) groups. Conclusion: The patency of midpalatal suture at coronal third level affects the amount of maxillary orthopedic protraction in pubertal patients with maxillary hypoplasia.

Indiana University-Purdue University Indianapolis (IUPUI)
Background: Suture expansion is a very important clinical approach to correct maxillary width deficiency, but it has a high potential for treatment relapse. Accelerating bone formation and mineralization in the midpalatal suture during suture expansion is beneficial in preventing relapse of the arch width and reducing the retention period. Pyk2 is tyrosine kinase which has been shown to mediate signaling pathways that are involved in the process of bone remodeling. Pyk2 knock-out (KO) mice have augmented bone formation and increased bone mass, suggesting that therapeutic strategies that inhibit Pyk2 may be useful to enhance bone remodeling and prevent suture relapse during suture expansion. Objectives: To determine if Pyk2-deficiency affects midpalatal suture bone mass and bone remodeling with or without suture expansion in mice. Methods: Thirty-six Pyk2-KO and thirty-six wild type (WT) 6 week-old male mice were randomly assigned into three groups: receiving no expansion force (0 g), 10 g or 20 g force of rapid maxillary expansion for 14 days. Half of the mice in each group were used for histology analysis; the other half was assigned for fluorescence analysis. Suture width, maxilla width and bone volume/tissue volume around suture bone edges were measured using micro-CT. Histological analyses of osteoclasts (tartrate resistant acid phosphatase, TRAP), osteoblasts (alkaline phosphatase, ALP) and chondrocytes (alcian blue) were performed. Results: The BV/TV ratio was significantly higher in Pyk2-KO control mice compared to WT control mice. Suture expansion in WT and Pyk2-KO mice led to an increase in bone marrow spaces around the suture edge and significantly reduced BV/TV. Expansion also led to a significant increase in suture width, suture fibrous area, osteoclast number, cartilage area and hypertrophic chondrocyte number. However, BV/TV in Pyk2-KO mice was significantly higher than in WT mice at both the 10 g and 20 g force levels. In addition, Pyk2-KO exhibited reduced suture width, maxilla width, fibrous area and osteoclast number per bone surface (OC.S/BS) compared to WT mice under expansion forces. Cartilage area and hypertrophic chondrocyte number were increased by force but were independent of mouse genotypes. Conclusion: Pyk2-KO mice have higher BV/TV and narrower suture width compared to WT mice, which may be due to decreased osteoclast activity. The higher BV/TV of the midpalatal sutures of Pyk2-KO mice following suture expansion may suggest the presence of a more stable suture that has a reduced potential for relapse. Therapeutic strategies to inhibit Pyk2 during RME may be beneficial in increasing bone mass and preventing relapse of the suture.