Search Results (33)

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

Background: This meta-analysis aimed to evaluate the dentoalveolar changes of miniscrew-assisted rapid palatal expansion (MARPE) compared with conventional rapid palatal expansion (CRPE) in growing patients (≤16 years). Methods: A systematic and comprehensive literature search was carried out independently by two reviewers using both MeSH terms and free-text keywords across PubMed, the Cochrane Library, and Embase, with studies published through February 2025 included. The risk of bias was assessed using the Cochrane ROB 2.0 tool. The GRADE system was employed to determine evidence quality. Results: Of the 462 initially screened articles, 6 met the inclusion criteria and were selected for quantitative synthesis. Most studies had a low risk of bias with some concerns in reporting. The pooled standardized mean difference (SMD) for tooth inclination changes in CRPE compared with MARPE was 0.98 (95% confidence interval (CI), 0.54 to 1.42; p < 0.01). The test for overall effect was significant (p < 0.01), but no significant differences were found between the subgroups. The pooled SMD for buccal bone thickness changes in CRPE compared with MARPE was 0.69 (95% CI, 0.37 to 1.00; p < 0.01). The test for overall effect was significant (p < 0.01), and there were substantial differences between the subgroups. The supporting evidence ranged in certainty from moderate to low. Conclusions: MARPE was more effective than CRPE in minimizing the buccal tipping and buccal bone loss of the maxillary first premolars and first molars. However, to further confirm these outcomes and guide evidence-based clinical practice, well-designed randomized controlled trials with long-term follow-up are necessary. Full article

Background/Objectives: MARPE expansion is known to produce maxillary skeletal expansion and cause subsequent increase in velopharyngeal, oropharyngeal, and nasal volume. While MARPE designs vary and may include combinations of traditional bands, traditional jackscrews, or milled/3D printed frameworks with other screw designs, there is no agreement on the techniques of MARPE expansion in adult patients. The aim of this case series is to describe a novel 3D-printed and 3D-designed midpalatal piezocorticotomy guide and its benefits for MARPE-assisted midfacial skeletal expansion. Materials and Methods: This case series showcases the results of successful MARPE expansion in adults and introduces the novel 3D-printed midpalatal piezocorticotomy guide. It compares the outcome of non-guided piezocorticotomy-assisted maxillary skeletal expansion and outlines the benefits of pre-planned 3D-guided midpalatal piezocorticotomy. Results: The MARPE expansion outcomes when combined with 3D-designed and 3D-printed midpalatal piezocorticotomy guides are shown to be predictable and capable of preventing asymmetric expansion along with asymmetric suture opening. The technique, in particular, allows for one to preserve the position of the nasal septum and prevents asymmetrical nasal septum dislodgement following maxillary skeletal expansion. Conclusions: The described novel midpalatal piezocorticotomy guide presents a significant improvement to adult midfacial techniques using MARPE expansion appliances. Full article

Industry 5.0 is transforming energy demand by integrating sustainability into energy planning, ensuring market stability while minimizing environmental impact for future generations. There are several patterns for calculating energy consumption depending on whether it is measured daily, monthly, or annually through the integration of artificial intelligence approaches, particularly Artificial Neural Networks (ANNs) and Random Forests (RFs), and within the framework of Industry 5.0. This study employs machine learning techniques to analyze energy consumption data from two distinct buildings in Spain: the LUCIA facility in Valladolid and the FUHEM Building in Madrid. The implementation was conducted using custom MATLAB code developed in-house. Our approach systematically evaluates and compares the predictive performance of Artificial Neural Networks (ANNs) and Random Forests (RFs) for energy demand forecasting, leveraging each algorithm’s unique characteristics to assess their suitability for this application. The performances of both models are calculated using the Root Mean Square Percentage Error (RMSPE), Root Mean Square Relative Percentage Error (RMSRPE), Mean Absolute Percentage Error (MAPE), Mean Absolute Relative Percentage Error (MARPE), Kling–Gupta Efficiency (KGE), and also the coefficient of determination, R². Training times are validated using ANN and RF models. Lucia RF took 2.8 s, while Lucia ANN took 40 s; FUHEM RF took 0.3 s, compared to FUHEM ANN, which took 1.1 s. The performances of the two models are described in detail to show the effectiveness of each of them. Full article

Background/Objectives: Miniscrew-assisted rapid palatal expansion (MARPE) has been increasingly used as a nonsurgical alternative for maxillary expansion in adults. However, reports of complications remain limited. This case describes a rare instance of maxillary bone fracture following MARPE and its clinical implications. Methods: A 32-year-old patient underwent MARPE as part of presurgical orthodontic treatment for maxillary constriction. Five days after activation, severe pain developed, followed by sensory disturbances in the infraorbital region. CT imaging revealed a maxillary fracture extending from the infraorbital foramen to the alveolar process. Symptoms gradually improved over two years, but psychological distress led to the abandonment of orthognathic surgery. Results: This case suggests that MARPE-induced maxillary fractures may be associated with stress concentration at the zygomatico-maxillary suture, particularly in individuals with increased midpalatal suture interdigitation and thin cortical bone. Finite element analysis and stress distribution studies indicate that the zygomatic buttress serves as a major resistance point, which may have contributed to the fracture. Conclusions: These findings highlight the importance of careful patient selection, preoperative CT assessments of bone thickness, and individualized expansion protocols. In high-risk cases, alternative approaches, such as surgically assisted expansion, may be considered. Further research on MARPE’s risk assessment and treatment protocols is needed to improve safety. Full article

Background/Objectives: The aim of this study is to investigate the side effects of two techniques of rapid maxillary expansion—Surgically Assisted Rapid Palatal Expansion (SARPE) and Miniscrew-Assisted Rapid Palatal Expansion (MARPE)—in adult patients, to guide the selection of the most cost-effective clinical treatment plan. Methods: The review protocol was developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis—extension for Scoping Reviews (PRISMA-ScR) guidelines. Eligibility criteria were defined based on the study objectives. The research team formulated a PICO question to identify relevant studies in the literature. Five databases were queried: MEDLINE (via PubMed), Scopus, Cochrane Library, Web of Science, and Embase. Additionally, a manual search was conducted. Results: The computer-assisted search identified 746 articles, of which only 26 fully met the inclusion criteria and were included in the scoping review. Among the included studies, 11 were retrospective, 12 were prospective, and 3 were randomized clinical trials. SARPE was evaluated in 21 studies, MARPE in 4 studies, and 1 article reported complications associated with both techniques. The side effects described in the studies were synthesized and categorized into five groups: expansion failure, asymmetric expansion, dentoalveolar issues, surgical complications, and appliance-related problems. Conclusions: The results indicate that both techniques involve risks. The most reported adverse effects were dentoalveolar and surgical in nature. Dentoalveolar side effects, such as dental tipping, were predominantly associated with the MARPE technique, while surgical complications were more commonly observed with the SARPE technique. Patient age is crucial for treatment choice as well as proper design and planning of the expansion device. Consequently, careful patient selection and treatment planning are essential to minimize the side effects of maxillary expansion in adult patients. Full article

Microimplant-assisted rapid palatal expansion (MARPE) is a technique widely used to treat transverse discrepancies in adult patients. The present study aims to examine how age, sex, maxillary width, and suture bone density might influence MARPE efficacy. It also analyzes bone density variations across the midpalatal suture regions. Materials and Methods: This retrospective study included 30 adult patients who underwent MARPE treatment. Pre- and post-treatment CT scans were analyzed to quantify the maxillary width and bone density measured in Hounsfield units (HUs) in the anterior, middle, and posterior nasal spine regions. Statistical analyses were carried out and included descriptive statistics, t-tests, and effect size calculations. Results: Younger patients (age 22.13 ± 4.58) had significantly higher success rates compared to older patients (aged 25.66 ± 4.67). No significant differences were found regarding sex or the initial maxillary width. Lower bone density in the middle and posterior nasal spine regions was correlated with higher success rates. Data showed that the anterior nasal spine exhibited higher bone density, but this finding did not affect treatment outcomes significantly. Conclusions: Age seems to be a crucial factor in MARPE success, with younger patients showing better outcomes. Regarding bone density, results showed that its values in the middle and posterior nasal spine regions could be a determinant of treatment success. On the contrary, sex and the initial maxillary width did not appear to affect outcomes. These findings emphasize the importance of preoperative assessments and the consideration of individual anatomical variations for optimal MARPE treatment planning. Full article

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

Background/Objectives: Hemolytic uremic syndrome (HUS) is a known cause of acute kidney injury in children, but there are few recent reports on its epidemiology and outcome. We aimed to investigate trends in the incidence and the long-term outcomes of both Shiga toxin-producing Escherichia coli -HUS (STEC-HUS) and atypical HUS (aHUS) in Poland over the last 12 years (2012—2023), based on the Polish Pediatric HUS and Pediatric Renal Replacement Therapy (RRT) Registries. Methods: A total of 436 patients (301 with STEC-HUS and 135 with aHUS) were included. Results: The incidence of STEC-HUS increased during the observation period, with a mean of 3.9 cases per million age-related population (marp). The incidence of aHUS was relatively constant with a mean of 1.8/marp. The majority of patients fully recovered, although kidney sequelae were observed at 5-year follow-ups in 31% of children with STEC-HUS, 57% of aHUS subjects in the pre-eculizumab era, and 37% of aHUS subjects who had received eculizumab. The overall mortality rate was 2% for STEC-HUS and 3.7% for aHUS, with no deaths reported in children on eculizumab and mortality mainly attributed to neurological damage. A decreasing incidence of chronic kidney disease stage 5 (CKD5) due to HUS was observed. Conclusions: Despite an unchanging incidence of aHUS and an increasing incidence of STEC-HUS, the kidney outcomes of both diseases have improved significantly over the last 12 years. Mortality from HUS has dropped due to improved symptomatic treatment and the introduction of anti-C5 therapy. The development of CKD5 in childhood as a consequence of HUS has become exceptional. Full article

Background: Miniscrew-assisted rapid palatal expansion (MARPE) has gained attention as an effective alternative to traditional rapid palatal expansion, particularly in adult patients. This scoping review synthesizes recent evidence to assess the clinical efficacy and safety of MARPE, addressing a gap in comprehensive, up-to-date analyses in this area. Objective: To present the recent assessments concerning MARPE influencing factors, side effects, soft tissue alterations, and airway changes, focusing on comparisons with conventional devices. Methods: Using PRISMA guidelines, we conducted a search of the literature published in 2018–2023 using Medline, Scopus, and Embase databases. This review focused on randomized controlled trials, cohort studies, and other reviews that evaluated the outcomes of MARPE. Results: Our analysis included 75 studies and revealed that MARPE significantly improves suture expansion with fewer dental and skeletal side effects compared to traditional methods. The technique shows high efficacy in subjects up to 25 years of age, with reduced incidence of complications and improved stability of expansion. Conclusions: The results support MARPE as a viable and superior alternative for maxillary expansion in late adolescents and adults. Given its advantages over traditional methods, MARPE should be considered a standard procedure in orthodontic treatment plans. Future research should focus on long-term outcomes and optimization of patient-specific treatment protocols. Full article

Class III malocclusion prevalence varies significantly among racial groups, with the highest prevalence observed in southeast Asian populations at 15.80%. These malocclusions often involve maxillary retrognathism, mandibular prognathism, or both, accompanied by maxillary constriction and crossbites. Comprehensive treatment should address anteroposterior, transverse, and vertical imbalances. Microimplant-assisted rapid palatal expansion (MARPE) has shown high success rates for transverse maxillary expansion in late adolescents and adults, presenting a viable alternative to surgically-assisted rapid palatal expansion (SARPE). This case report aims to demonstrate the successful treatment of a young adult female with borderline Class III malocclusion using MARPE and mandibular backward rotation (MBR) techniques. A 21-year-old female presented with a Class III skeletal pattern, anterior/posterior crossbites, and mild dental crowding. Despite her concerns about a concave facial profile, the patient declined orthognathic surgery due to a negative experience reported by a friend. The treatment plan included MARPE to correct maxillary transverse deficiency and MBR to alleviate Class III malocclusion severity. Lower arch distalization was performed using temporary anchorage devices (TADs) on the buccal shelves, and Class II elastics were used to maintain MBR and prevent retroclination of the lower labial segment during anterior retraction. Significant transverse correction was achieved, and the severity of Class III malocclusion was reduced. The lower dentition was effectively retracted, and the application of Class II elastics helped maintain MBR. The patient’s final facial profile was harmonious, with well-aligned dentition and a stable occlusal relationship. The treatment results were well-maintained after one year. The MARPE with MBR approach presents a promising alternative for treating borderline Class III cases, particularly for patients reluctant to undergo orthognathic surgery. This case report highlights the effectiveness of combining MARPE and MBR techniques in achieving stable and satisfactory outcomes in the treatment of Class III malocclusion. Full article

Within rowing, lower back disorders (LBDs) are common, but the mechanisms underpinning LBDs are poorly understood. Considering this, it is essential to understand how coordination and motor control change under different constraints such as ergometer rowing and fatigue. This can help better inform movement features linked to LBDs. Measurement of the continuous relative phase (CRP) is a method used to quantify body segment and joint coordination, as CRP measures the spatiotemporal control of multi-joint movement. The purpose of this study was twofold: to examine the general spatiotemporal coordination aspects of ergometer rowing in an unfatigued state, and to quantify how the spatiotemporal coordination of a rowing movement changes in response to a fatigue-inducing rowing trial. Wearable IMUs monitored 20 participants’ movement during a 2000 m ergometer row. The Borg-10 Rating of Perceived Exertion (RPE) scale was used to quantify perceived fatigue. Despite significant RPE increases across all athletes, the spatiotemporal coordination of rowing revealed prevailing strategies for the lumbar spine and lower extremity but no significant effects (α = 0.05) of fatigue on CRP outcomes (MARP, DP), cross-correlation lag (R_XY), or range of motion. These findings provide further insight into rowing movements and support the idea that heterogeneous responses to fatigue may exist, requiring further study. Full article

(1) Objective: This scoping review evaluates the effects of miniscrew-assisted rapid palatal expansion (MARPE) on different regions of the upper airway in adult patients and investigates various methods of measurement. (2) Methods: The search encompassed Pubmed, Cochrane Library, Scopus and Web of Science. This review was conducted following the PRISMA_ScR guidelines, and the inclusion criteria for examined studies were chosen in accordance with the PICOS framework. (3) Results: Seven studies were included in this review, comprising four retrospective studies, one prospective and two case reports. All studies involved the use of Cone Beam Computed Tomography (CBCT) for measurements of the areas of interest. The percentage of increase in the volume of the nasal cavity varied between 31% and 9.9%, depending on the study. Volumetric variations in the nasopharynx were reported as increases between T0 (before expansion) and T1 (immediately after expansion) of 6.4%, 20.7% and 14.1%. All studies considered T0 before expansion and T1 immediately after expansion. Only one study evaluated remote follow-up to assess if the results were maintained after one year. (4) Conclusions: MARPE appears to lead to a statistically significant increase in the upper airway, especially in the nasal cavity and nasopharynx immediately after expansion. However, further prospective and retrospective trails with long-term controls are required to verify the effects of MARPE on the upper airway. Full article

The most common inflammatory reactions in the oral mucosa are found at the gingival level. The treatment of these inflammations requires, first of all, the removal of the causative factor; often, this maneuver is sufficient. The aim of this retrospective study was to evaluate clinical and histopathological changes that occur in terms of gingival and palatal mucosa enlargement during palatal expansion treatment and their evolution during treatment. Twenty-five (n = 25) research participants, aged between thirteen and twenty-six years old, were examined in this retrospective study. At the end of the treatment, fragments of tissue from the affected level were obtained via incisional biopsy and sent to the histopathology laboratory for a specialized examination. The changes identified were specific to mechanical traumatic injuries, thus excluding hyperplasia from other etiologies (infectious, tumoral, or non-mechanical traumatic). The examined fragments showed hyperplasia. The histopathological examination revealed the mechanical character of the lesion, strengthening the causal relationship between the insertion of the expander and the occurrence of hyperplasia of the palatal mucosa. The type of palatal expander influenced the degree of inflammation, with the severity of hyperplasia being more pronounced in the case of mini-implant-anchored rapid palatal expander (MARPE) usage than in the case of tooth-borne rapid palatal expander (RPE) usage. The analysis of the distance between the expander and the palatal mucosa did not provide conclusive results; the incidence and severity of the reaction were variable in patients with the same distance between the expander and the palatal or gingival mucosa. Full article

The aim of this systematic review and meta-analysis was to evaluate the density of the midpalatal suture (MPS) of individuals with maxillary expansion (rapid maxillary expansion, RME), surgically assisted rapid maxillary expansion (SARPE), and miniscrew-assisted rapid palatal expansion (MARPE) through computed tomography. An electronic search was performed in four databases, MEDLINE via PubMed, SCOPUS, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) in February 2023 and updated in April 2023, using previously established search strategies. Studies were retrieved without restrictions in terms of data, language, or publication status. The risk of bias assessment was based on a quality assessment tool for before-and-after studies. Ten studies were included in our systematic review, and nine studies were included for our quantitative analysis. The analyses were performed by subgroup according to the evaluation of the region, anterior, middle, and posterior, including the three types of treatment: RME, SARPE, and MARPE. Heterogeneity was high for the three regions (anterior 95%, medium 97%, and posterior 84%) and a statistical difference was found in two of the three regions (anterior p = 0.06, medium p = 0.031, and posterior p < 0.001). There is not enough evidence to state that the MPS density is different after 6 months of RME in the anterior and middle regions; the bone density values for SARPE and MARPE suggest that 6 or 7 months after expansion, there is still no bone density similar to the initial one in the three regions. Full article