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Background and Objectives: The aim of this prospective study was to assess the effects of rapid maxillary expansion (RME) and/or face mask (FM) treatments on the pharyngeal airway in patients with skeletal Class III malocclusion caused by maxillary deficiency. This study utilized cone beam computed tomography (CIBT) for a three-dimensional (3D) analysis of airway changes, comparing the results with those of a control group consisting of untreated skeletal Class III patients. Materials and Methods: The study included 60 participants (34 boys, 26 girls) aged 9 to 14 years, all diagnosed with skeletal Class III malocclusion due to maxillary underdevelopment. The participants were divided into four treatment groups, each consisting of 15 individuals: Group 1—RME; Group 2—RME/FM; Group 3—FM; Group 4—Control group. The pharyngeal airway measurements were evaluated using CBCT and analyzed with Dolphin 3D software (version 11.9). Volumetric parameters and minimal axial area (MAA) were measured in the nasopharyngeal, retropalatal, retroglossal, and total airway regions. The collected data were statistically analyzed using SPSS 20.0 software. Results: The results indicated significant changes in pharyngeal airway volumes across all treatment groups compared to the control group. A statistically significant increase in nasopharyngeal, retropalatal, and total airway volume were observed in all treatment groups. Only the RME group demonstrated a significant increase in retroglossal volume. Significant increases in MAA were found in the RME/FM and FM groups in the nasopharyngeal and retropalatal regions. However, minimal changes were observed in the retroglossal region across all treatment groups. The control group showed no significant changes in any of the measured parameters, underscoring the effects of the treatments. Conclusions: The findings of this study suggest that both RME and/or FM treatments result in significant positive changes in the pharyngeal airways, particularly in the nasopharyngeal and retropalatal regions. The retroglossal region showed more limited response to the treatments. The combined RME/FM therapy was found to be particularly effective in improving airway dimensions in the anterior and mid-pharyngeal regions. These results highlight that early orthodontic interventions, such as RME and FM, can improve both airway patency and overall respiratory function, in addition to addressing skeletal Class III malocclusion.

ObjectivesThe aim of this study was to compare the upper airway space changes after miniscrew-anchored maxillary protraction with hybrid (HH) and conventional hyrax (CH) expanders.Material and methodsThe sample comprised Class III malocclusion growing patients that were randomized into two groups of miniscrew-anchored maxillary protraction. The group HH was treated with a hybrid hyrax appliance in the maxilla and two miniscrews distally to the canines in the mandible. Class III elastics were used from the maxillary first molar to the mandibular miniscrews until anterior crossbite correction. The group CH was treated with a similar protocol except for the conventional hyrax expander in the maxilla. Cone-beam computed tomography was obtained before (T1) and after 12 months of therapy (T2). The shape and size of upper airway were assessed. Intergroup comparisons were performed using Mann-Whitney U test (p < 0.05).ResultsThe group HH was composed of 20 patients (8 female, 12 male) with a mean age of 10.76 years. The group CH was composed of 15 patients (6 female, 9 male) with a mean age of 11.52 years. Anteroposterior and transverse increases of the upper airway were found for both groups. The oropharynx and the most constricted area increased similarly in both groups.ConclusionsNo differences in upper airway changes were observed using protraction anchored on hybrid or conventional hyrax expanders.Clinical relevanceMaxillary protraction anchored on hybrid or conventional hyrax expanders may benefit patients with breathing disorders due to the increase of the upper airway volume and most constricted area. Registration: ClinicalTrials.gov (NCT03712007).

BackgroundThe introduction of bone-anchored maxillary protraction eliminated the side effects of facemask in the early treatment of patients with maxillary retrusion. This study aimed to evaluate the effects of miniscrew-anchored maxillary protraction (MAMP) and compare them with the growth changes in an untreated control group in growing patients with Class III malocclusion. MethodsForty growing patients with Class III malocclusion and retrognathic maxilla were randomly allocated into two groups: treated and control groups. In the treated group, patients were treated with full-time intermaxillary Class III elastics (C3E) anchored by a hybrid hyrax (HH) in the maxilla and a bone-supported bar in the mandible. Protraction was stopped after obtaining a positive overjet. Cephalometric radiographs were acquired before and after the treatment. Data were statistically analyzed on an intention-to-treat basis. Intergroup comparisons were also made using analysis of covariance with the readings at T0 as a covariate.ResultsForty patients agreed to participate, and 30 of them completed the study (treated group, n = 17; control group, n = 13). The average treatment duration was 11.9 months. MAMP resulted in a significant maxillary advancement (A-VR, 4.34 mm) with significant control over the mandibular growth. No significant increase in the mandibular plane angle was found in the treated group compared with the control group. The upper and lower incisors showed significant protrusion in the treated group.ConclusionsWithin the limitations of this study and high attrition rate, the MAMP protocol can effectively increase maxillary forward growth with good control over the growth of the mandible antero-posteriorly and vertically.

Background Early intervention in Class III malocclusion aims to prevent the need for surgery in adulthood by enhancing upper jaw growth while limiting lower jaw development. Although traditional facemask treatment remain common, bone-anchored devices are increasingly used, claiming better skeletal control and patient compliance. However, strong evidence supporting these advantages is limited. Methods Single-center, parallel-group, randomized controlled trial with 1:1 allocation ratio. Participants:  28 growing Class III patients (mean age 9.7 ± 1.3 years) in mixed dentition with skeletal class III malocclusion. Interventions:  Patients were randomly assigned to either hybrid hyrax with facemask (HH + FM, n = 14) or hybrid hyrax with mentoplate (HH + MP, n = 14). All received Alt-RAMEC protocol expansion. FM group used 360–400 g/side elastic traction 12–14 h daily; MP group used 185 g/side continuous traction. Objective:  To compare 5-year three-dimensional (3D) skeletal effects between HH + FM and HH + MP protocols. Outcome:  Primary outcome was 3D volumetric changes of upper and lower jaw at 1 year (T1) and 5 years (T2) post-treatment, measured using low-dose CT scans. Randomization: 28 patients were allocated to either treatment-protocols using sequentially numbered opaque, sealed envelopes. The randomization sequence was generated with a 1:1 allocation ratio. Blinding: Due to the nature of the trial, the operator and children could not be blinded to the treatment allocation. However, blinding was used when assessing the outcomes. Results Follow-up: one patient was lost at the one-year follow-up and an additional three patients were lost at the 5-year-follow-up. Outcomes: At T2 (5 years), maxillary advancement was identical between both groups (0.85 mm ± 0.5). Mandibular growth control showed minimal difference (FM: − 0.01 mm ± 0.24; MP: 0.10 mm ± 0.33). No significant differences were found between groups for any skeletal measurements ( p  > 0.05). Male patients showed lager mandibular changes both signed ( p  < 0.03) and unsigned ( p  < 0.01). Harms: minor harms were encountered with the anchor hooks (fracture or mucosal irritation), however none led to treatment cessation. Conclusions Both protocols demonstrated comparable long-term skeletal effects in Class III correction. Treatment choice should be based on individual patient factors rather than assumed mechanical advantages.

IntroductionOrthodontic treatment using face mask protraction combined with an alternate rapid maxillary expansion and constriction/protraction face mask (Alt-RAMEC/PFM) protocol is effective in the early treatment of patients with class III malocclusion, but the stability of treatment outcomes represents a major concern. Previous studies have suggested that tonsillar hypertrophy can be a risk factor for class III malocclusion and tonsillectomy may prompt the normalisation of dentofacial growth. However, these studies had a low-to-moderate level of evidence. This study was designed to identify the impact of tonsillectomy before orthodontic treatment on the efficacy and stability of Alt-RAMEC/PFM protocols and the sleep quality and oral health in children with anterior crossbite and tonsillar hypertrophy.Methods and analysisThis is a two-arm, parallel-group, superiority cluster randomised controlled trial, with four clinics randomly assigned to the surgery-first arm and the orthodontic-first arm in a 1:1 ratio. The Alt-RAMEC protocol involves alternate activation and deactivation of the expander’s jet screw over 6 weeks to stimulate maxillary suture distraction. Patients will be instructed to wear the PFM for a minimum of 14 hours per day. The primary outcomes are changes in Wits appraisal and the degree of maxillary advancement from baseline to the end of orthodontic treatment. Lateral cephalometric radiographs, polysomnography, Obstructive Sleep Apnoea-18 questionnaire and Oral Health Impact Profile-14 questionnaire will be traced, collected and measured. We will recruit 96 patients intofor the study. To assess differences, repeated multilevel linear mixed modelling analyses will be used.Ethics and disseminationThis study has been granted ethical approval by the Ethics Committee of the School & Hospital of Stomatology, Wuhan University (approval No. 2023-D10). Written informed consent will be obtained from the participants and their guardians. The results of the trial will be disseminated through academic conferences and journal publications.Trial registration numberChiCTR2300078833.

ObjectiveThis prospective controlled study evaluated the effect of bone-anchored maxillary protraction therapy in cleft children with Class III malocclusion using CBCT-derived 3D surface models.Materials and subjectsEighteen cleft patients between 10 and 12 years old were included. Intermaxillary elastics were worn after the placement of four zygoma bone plates for 18 months. Uniquely, three age-matched untreated groups including both cleft subjects and non-cleft subjects with Class III malocclusion served as controls. Profile photos and CBCT scans for each patient were taken before (T0) and 18 months after the protraction (T1). 3D measurements were made on CBCT surface models from the treatment group using tomographic color mapping method. Cephalometric measurements were made on lateral cephalogram reconstructed from the CBCT scans and were compared with those obtained from the control groups.ResultsTwo thirds of the treatment subjects showed improved lip projection towards more convex facial profile. The most significant skeletal changes on 3D surface models were observed at the zygomatic regions (mean 1.5-mm forward, downward, and outward displacement) and at the maxillary complex (mean 1.5-mm forward displacement). Compared with the control groups, the treatment subjects showed significant increase in the SNA and ANB angles, increased Wits appraisal, a more forward movement of point A and overjet improvement (p < 0.05).ConclusionsBAMP in cleft patients gives a significant forward displacement of the zygomaxillairy complex in favor of the Class III treatment.Clinical relevanceThis treatment method shows clearly favorable outcome in cleft patients after 1.5 years of BAMP.

Purpose PEMF (pulsed electromagnetic fields) founds application in several medical fields to accelerate bone wounds healing and to reduce inflammation. The aim of our study was to evaluate the effectiveness of PEMF in reducing postoperative swelling and pain in patients undergoing orthognathic surgery. Methods A prospective observational monocentric study was conducted on a sample of 30 patients undergone to orthognathic surgery in Maxillofacial Surgery Unit of University of Naples Federico II. The patients who followed these inclusion criteria were enrolled in the study: age ≥ 18 years, Class III malocclusion, Surgical procedure of Le Fort I osteotomy + Bilateral Sagittal Split Osteotomy (BSSO), Written informed consent. Patients were divided into two groups: Group SD) postoperative standard treatment with medical therapy and cryotherapy, Group SD + PEMF) postoperative standard therapy + PEMF. Each patient underwent a 3D facial scan, at one (1d) and four (4d) days after surgery to compare the swelling reduction. The pain score was assessed through VAS score and analgesics administration amount. Results In SD + PEMF group, the facial volume reduction between 1d and 4d scan was on average 56.2 ml (6.23%), while in SD group, it was 23.6 ml (2.63%). The difference between the two groups was 3.6% ( p  = 0.0168). VAS pain values were significantly higher in SD group compared to SD + PEMF group in the second day after surgery ( P  = 0.021) and in the total 4 days ( P  = 0.008). Conclusions Our data suggest that PEMF is valid tool to promote faster postoperative swelling and pain reduction in patients undergoing orthognathic surgery.

Background In adults, mini-screw-assisted rapid palatal expansion (MARPE) has proven to be an efficient method for overcoming the drawbacks of conventional expansion methods. In treating adult patients with anteroposterior deficient maxilla, the clinician had to decide between an intrusive surgical approach or a camouflage therapy to mask the Class III malocclusion. However, alternate rapid maxillary expansion and constriction (ALT-RAMEC) is the treatment of choice in younger patients. Methods The 7-week ALT-RAMEC protocol was modified and combined with MARPE to evaluate its efficiency and its sutural and dentoskeletal advantages over conventional MARPE in young adults. Twenty-nine patients with transverse and anteroposterior maxillary deficiency (mean age of 21.3) were randomly assigned to two groups. The conventional group received MARPE with its conventional expansion rate (Control group), while the ALT-RAMEC group was treated with a combination of MARPE and the ALT-RAMEC modified protocol. The efficiency of expansion, circummaxillary sutural displacement, and dentoskeletal effects were assessed. Analysis of the change before and after intervention was examined using paired t-tests while analysis of the parameters comparing the two groups was examined using an independent t-test. For variables that were not normally distributed, the p-value was obtained from Bootstrap for pairwise comparison (BCA). Results The two techniques showed 100% efficiency in producing expansion in both groups. Mid-palatal, frontonasal, and intermaxillary sutures were displaced and increased significantly in width after treatment with both protocols ( p  ≤ 0.001), while the zygomaticomaxillary sutures compressed and showed a significant decrease in width with conventional MARPE, though, expanded and increased significantly in width with the ALT-RAMEC group ( p  < 0.001). The dentoskeletal effects revealed that conventional MARPE produced a buccal molar tipping while ALT-RAMEC showed a more bodily movement of the anchor molars. Conclusion The modified ALT-RAMEC technique is a promising protocol sufficient to expand the maxilla transversely without tipping the anchored teeth in young adult patients. The successful subluxation of circummaxillary sutures might be a sign of hope for maxillary anteroposterior deficient patients if proven to aid in non-surgical maxillary protraction. Trial registration The study protocol was registered in ClinicalTrials.gov public website under the name “New Maxillary Expansion Technique in Adults” with identifier number “NCT04908540”, and registration dates: 25-05-2021 (First submitted) and 01-06-2021 (First posted).

Objective The objective of the study is to evaluate the skeletal, dentoalveolar and soft tissue changes before and after treatment with Alt-RAMEC protocol and protraction headgear in comparison to the controls. Material and methods A quasi experimental study was conducted in the orthodontic department on 60 patients of cleft lip and palate. These patients were divided into two groups. Group I was the Alt-RAMEC group that underwent Alt-RAMEC protocol followed by facemask therapy while group II was the control group that underwent RME and facemask therapy. Total treatment time in both the groups was approximately 6 to 7 months. Mean and standard deviation was calculated for all the quantitative variables. Pre and post treatment changes between treatment and control groups were made using paired t-test. Intergroup comparison between treatment and control group was analyzed using independent t-test. Significance for all tests was predetermined at a P -value of  ≤ 0.05. Results The Alt-RAMEC group showed significant forward movement of maxilla and improvement in the maxillary base. A remarkable improvement in SNA was seen. The overall outcome was better maxillo-mandibular relationship as shown by positive ANB values and angle of convexity. More effect on maxilla and least effect on mandible was notified with Alt-RAMEC protocol and facemask therapy. Improvement in transverse relationship was also evident in the Alt-RAMEC group. Conclusion Alt-RAMEC protocol in combination with protraction headgear is a better alternative to treat cleft lip and palate patients in comparison to the conventional protocol.

Background: Insufficient evidence regarding the effects of chincup therapy on the mandibular dimensions and temporomandibular joint (TMJ) structures requires high-quality studies using three-dimensional (3D) imaging. This trial aimed to evaluate the 3D changes in the mandible, condyles, and glenoid fossa after chin cup therapy for skeletal Class III children compared to untreated controls. Methods: A 2-arm parallel-group randomized controlled trial on 38 prognathic children (21 boys and 17 girls), with mean ages 6.63±0.84 years. Patients were recruited and randomized into two equal groups; the experimental group (CC) was treated with occipital-traction chin cups in conjunction with bonded maxillary bite blocks. No treatment was provided in the control group (CON). Low-dose CT images were acquired before (T1) and after achieving  (2-4 mm) positive overjet (T2), and after 16 months apart in both groups. The outcome measures of the condyle-mandibular 3D distances, the condyles-glenoid fossa postional changes, and the quantitative displacement parameters of superimposed 3D models were compared statistically. Paired- and two-sample t-tests were used for intra- and inter-group comparisons, respectively. Results: Overall, 35 patients (18 and 17 in the CC and the CON groups, respetively) were enrolled in the statistical analysis. The mean mandibular and condylar volumes increased significantly by 777.24 mm 3 and 1,221.62 mm 3, 94.57 mm 3, and 132.54 mm 3 in the CC and CON groups, respectively. No statistically significant differences were observed between the groups regarding the volumes, superficial areas, and linear changes of the mandible and condyles, and part analysis measurements, except the changes of the relative sagittal and vertical positions of condyles, glenoid fossa, and posterior joint space, which were significantly smaller in the CC group (p<0.05) than the CON group. Conclusions: The chin cup did not affect the mandibular dimensions. Its primary action was confined to the condyles and the TMJ internal dimensions. Clinicaltrials.gov registration: NCT05350306 (28/04/2022).