Search Results (141)

Background/Objectives: This study aimed to evaluate the immediate effects of a 2-hinged expander activated with the alternate rapid maxillary expansion–constriction (Alt-RAMEC) protocol on craniofacial structures and the soft tissue periodontium in adolescents with skeletal Class III malocclusion characterized by maxillary retrusion. Methods: Lateral cephalograms obtained at baseline (T0) and immediately after treatment (T1) from 15 adolescents (6 females, 9 males; mean ages 12.6–13.1 years) treated with a 2-hinged expander using a 9-week Alt-RAMEC protocol were analyzed. A control group consisted of 27 untreated Class III individuals (7 females, 20 males; mean ages 12.5–12.6 years). Sagittal and vertical skeletal, dental, and soft tissue measurements were assessed using a Cartesian coordinate system. Periodontal parameters of supporting teeth were evaluated at T0 and T1. Statistical analysis was performed using the Mann–Whitney U and Wilcoxon tests (p < 0.05). Results: Significant anterior maxillary displacement was observed in the treatment group compared with controls (p < 0.01), accompanied by increases in overjet and Wits appraisal (p < 0.05), while mandibular position remained unchanged. The upper lip advanced in accordance with skeletal changes (p < 0.05). Gingival index, bleeding index, and probing pocket depth increased significantly in supporting teeth (p < 0.05), whereas plaque index remained stable (p > 0.05). Conclusions: The 2-hinged expander combined with a 9-week Alt-RAMEC protocol induces immediate skeletal maxillary advancement in growing Class III patients with minimal dental compensation. Short-term periodontal changes suggest a transient inflammatory response associated with appliance therapy. Full article

Aim: Rapid maxillary expansion (RME) is a widely used interceptive orthodontic procedure in pediatric patients that is often associated with discomfort and pain, particularly during the initial phase of treatment. The present study aims to analyze the intensity and temporal trend of pain perceived by pediatric patients undergoing rapid palatal expansion (RME) by evaluating the influence of factors such as age, sex, type of maxillary transverse deficit, palatal expander, and dental anchorage. Materials and Methods: A prospective observational study was conducted on 134 pediatric patients (mean age 8 years; range 6–14 years) diagnosed with transverse maxillary contraction. Patients were treated with tooth-borne Haas or Hyrax expanders. Pain perception was monitored daily using a specific questionnaire with answers based on the Wong–Baker FACES scale. Collected data were analyzed by using the ANOVA test (p < 0.05). Results: Pain was a common symptom, with greater intensity in the first days of treatment. The Hyrax expander was associated with significantly greater initial pain than the Haas one (p < 0.001). Tooth-borne expanders on the first permanent molars resulted in greater initial pain than anchorage on the second primary molars (p < 0.001). Patients with unilateral posterior crossbite and anterior crossbite reported higher average pain levels (p < 0.001). Age emerged as a significant modulator of pain (p < 0.001), while no significant differences were found based on sex (p = 0.287). Conclusions: Expander type, tooth-anchorage type, maxillary transverse contraction type, and patient age significantly influenced pain perception during pediatric RME. These results provided useful indications for the clinical management of the patient, for the choice of expander and anchorage type and for the timing of intervention. Full article

Background/Objectives: Orthodontic mini-implants have become indispensable in modern orthodontics due to their ability to provide absolute anchorage, independent of patient compliance. Our research aims to illustrate the versatility of mini-implants in addressing diverse biomechanical challenges across different planes of tooth movement (sagittal, transverse, and vertical) based on a retrospective clinical analysis. Methods: A retrospective analysis of orthodontic treatments performed with mini-implants (Dual Top and JS systems) was conducted, focusing on predefined biomechanical objectives and outcomes. The analysis encompassed distinct biomechanical applications, including incisor retraction and space closure using sequential direct and indirect anchorage; transverse and vertical correction of adult open bite through mini-implant–assisted rapid palatal expansion (MARPE) and molar intrusion; deep bite correction via simultaneous upper and lower incisor intrusion; and unilateral molar distalization using palatal skeletal anchorage. Results: Mini-implants provided stable, reproducible anchorage in all cases, enabling complex three-dimensional tooth movements with minimal side effects. Sequential reuse of the same mini-implants for both indirect and direct anchorage reduced treatment invasiveness and enhanced anchorage efficiency. Combined skeletal expansion and posterior intrusion allowed improved transverse and vertical control in adult open-bite presentations. Pure incisor intrusion was achieved without molar extrusion or incisor proclination, while unilateral molar distalization was effectively managed using palatal skeletal anchorage. Across all cases, mini-implants enhanced treatment efficiency, reduced the need for auxiliary appliances, and ensured predictable outcomes. Conclusions: Orthodontic mini-implants represent a highly versatile and minimally invasive anchorage system adaptable to a broad range of biomechanical situations. Their ability to provide stable, reusable, and site-specific anchorage supports efficient correction of complex malocclusions and reinforces their pivotal role in contemporary orthodontic practice. Full article

Objectives: This systematic review aimed to evaluate the effectiveness of currently available methods for the diagnosis and monitoring of skeletal, dental, and soft tissue changes, as well as the adequacy of follow-up protocols, in adolescents and adults treated with miniscrew-assisted rapid palatal expansion (MARPE). Materials and Methods: This systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive electronic literature search was performed across five databases (PubMed, Scopus, Embase, Cochrane, and Web of Science) to identify prospective and retrospective clinical studies evaluating dental, periodontal, and alveolar bone outcomes associated with MARPE in late adolescent and adult patients. Study selection, data extraction, and risk of bias assessment were independently performed by two reviewers. Risk of bias was assessed using the ROBINS-I tool for non-randomized studies and the RoB 2 tool for randomized studies. The certainty of the evidence was evaluated using the GRADE approach. Owing to substantial methodological heterogeneity and limited follow-up duration, a structured qualitative (narrative) synthesis of the results was performed. Results: A total of 20 studies were included in the systematic review. The reported adverse events primarily involved hard and soft tissues and were identified using cone-beam computed tomography (CBCT), clinical and periodontal examination, panoramic and cephalometric radiography, and digital dental casts. Dental effects, including dental tipping, were frequently reported across the included studies. Alveolar bone loss was reported in 11 studies, buccal alveolar bone dehiscence in 3 studies, and failure of palatal suture opening in 6 studies. In most of the included studies, follow-up was either not reported or limited. Conclusions: The MARPE technique appears to be potentially effective in achieving transverse maxillary expansion in late adolescent and adult patients. However, the included studies report possible adverse events affecting periodontal and alveolar bone tissues, such as alveolar bone thinning and gingival hypertrophy, the assessment of which requires an integrated diagnostic approach combining CBCT imaging with clinical and periodontal examination. Overall, the certainty of the available evidence was low to very low, mainly due to a high risk of bias, methodological heterogeneity, and limited or absent follow-up in most studies. Therefore, the results should be interpreted with caution. Well-designed prospective controlled studies with standardized protocols and long-term follow-up are needed to conclusively evaluate the safety and long-term clinical stability of the MARPE technique. Full article

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by repeated upper airway collapse during sleep, significantly impacting quality of life. Orthodontists are increasingly recognized for their role in screening and managing anatomical factors contributing to airway obstruction. One such intervention is rapid maxillary expansion (RME), originally developed to address transverse maxillary deficiencies but now also studied for its influence on nasal and oropharyngeal airway dimensions. This literature review evaluates the effects of maxillary palatal expansion on airway volume and respiratory function. Evidence consistently shows increases in nasal cavity volume and reductions in nasal airway resistance, particularly in patients treated before the peak of skeletal growth. Some studies reported improvements in sleep outcomes and enhanced oxygen saturation following MARPE in adults with OSA. Results regarding changes in oropharyngeal volume were more variable, with several studies showing significant expansion. Factors influencing outcomes include patient age, skeletal maturity, appliance type, and aging modality. Hybrid and bone-borne expanders generally demonstrated greater skeletal effects compared to tooth-borne devices, though statistical significance was not always reached. While MARPE has shown promising results in non-obese adults with OSA, long-term stability of airway improvements and translation into consistent functional respiratory benefits remain uncertain. Overall, maxillary expansion demonstrates measurable skeletal and airway changes, with the greatest respiratory improvements in growing patients and selected adult populations. Incorporating patient-reported outcomes and standardized polysomnographic measures in future trials will be critical to determine whether these structural gains consistently translate into durable improvements in sleep-disordered breathing and quality of life. Full article

Objectives: The aim of the current study was to evaluate changes in olfactory sensitivity with Sniffin’ Sticks^® (Burghart Messtechnik, Germany) in patients undergoing palatal expansion. Methods: The study sample consisted of 20 patients enrolled from the Department of Paediatric Dentistry (0–14 years old) at the Policlinico of Rome “Tor Vergata”, according to the following inclusion criteria: negative posterior transverse interarch discrepancy ≥ 4 mm, mixed dentition phase with first permanent molars erupted and prepubertal skeletal maturation stage (CS1-2), evaluated on a lateral radiograph through the Cervical Vertebral Maturation (CVM) method. Each patient underwent a dental examination, orthopantomography and lateral cephalometric X-rays were requested, and dental impressions were taken using digital scanner. Every patient was treated with maxillary rapid expander and underwent ear, nose, and throat (ENT) assessment before and after treatment. Moreover, questionnaires before and after treatment to obtain a subjective assessment of their olfactory perception were given to all participants. Results: About odor identification, the analyses revealed an increase in mean scores of 1.28; however, this change, although slight, did not reach statistical significance (Z = −1.85; p = 0.064). In contrast, about odor discrimination, the test results indicated a statistically significant increase in the children’s scores of 3.41 (Z = −2.87; p < 0.001). Conclusions: This study supports the hypothesis that rapid maxillary expansion (RME) can improve olfactory function by enhancing nasal airway dimensions and airflow. Further studies are required to confirm these results. Full article

Background: Impaired mucus drainage from the paranasal sinuses is often associated with nasal obstruction and reduced airway function in growing patients. Orthopedic maxillary protraction and expansion techniques can enhance airway dynamics, but their underlying fluid–structure mechanisms remain insufficiently understood. Objective: To validate that the Right Angle Maxillary Protraction Appliance (RAMPA), combined with a semi-rapid maxillary expansion (sRME) intraoral device gHu-1, improves mucus drainage by enhancing nasal airflow through nasal cavity expansion. Methods: The effects of RAMPA therapy were analyzed using computational fluid dynamics (CFD) for single-phase (air) and two-phase (air–mucus) flows within the nasal cavity, employing the unsteady RANS turbulence model. Finite element method (FEM) results from prior studies were synthesized to assess changes in the center and radius of maxillary rotation induced by RAMPA-assisted sRME. A male patient (aged 8 years 7 months to 11 years 7 months) treated with extraoral RAMPA and the intraoral appliance (gHu-1) underwent pre- and post-treatment cone-beam computed tomography (CBCT) and ear, nose, and throat (ENT) evaluation. Results: FEM analysis revealed an increased radius and elevated center of maxillary rotation, producing expansion that was more parallel to the palatal plane. CFD simulations showed that nasal cavity expansion increased airflow velocity and pressure drop, enhancing the suction effect that promotes mucus clearance from the frontal sinus. Clinically, nasal passages widened, paranasal opacities resolved, and occlusal and intermolar widths improved. Conclusions: RAMPA combined with sRME improves nasal airflow and maxillary skeletal expansion, facilitating paranasal mucus clearance and offering a promising adjunctive approach for enhancing upper airway function in growing patients. Full article

Background/Objectives: Assessment of the midpalatine suture is vital for making clinical decisions regarding the correction of transverse growth discrepancies of the maxilla. Several studies have used Cone Beam Computed Tomography (CBCT) to evaluate skeletal maturity by midpalatine suture staging (MPS) in various populations. A few patterns of staging did not fit the standard classification. Hence, the rationale of this research was to explore potential new subcategories of maturation staging using CBCT. The study aimed to develop a new comprehensive classification subcategorization system for midpalatine suture maturation staging based on CBCT scans. Methods: The study involved the retrospective analysis of 168 CBCT scans. The standard reference for MPS staging was taken from a previous published classification in 2013 using CBCT. Each classification stage of the standard classification was subcategorized into Pattern A and Pattern B. Results: Both classifications (standard reference and new) can rely on age to predict the possibility of maturation of the MPS compared to non-maturation. Age is a predictable variable of suture opening in both classifications. Conclusions: The new classification demonstrated increased sensitivity in detecting midpalatine suture maturity and also increased the likelihood of utilizing non-surgical maxillary expansion compared to the previous classification. Evaluating suture staging in individual cases using CBCT is recommended for personalized diagnosis and optimal treatment planning for maxillary expansion. This advancement allows clinicians to use the new classification as a reliable tool to confidently predict non-surgical expansion success for more mature patients, thereby broadening the scope of orthodontic treatment without compromising patient outcomes. Full article

Background: This case report aimed to quantify dental, alveolar, and skeletal changes, periodontal health, and sleep quality after treatment with a tooth-borne rapid palatal expander (RPE) in a young adult with bilateral posterior crossbite due to transverse maxillary deficiency. Tooth-borne RPE is typically indicated during the prepubertal or pubertal growth phases; however, some post-pubertal or young adult patients may still present with incomplete maturation of the midpalatal suture—the so-called “gray zone.” In clinical practice, treatment decisions should ideally consider multiple skeletal resistance areas (the zygomaticomaxillary buttress, the pterygomaxillary junction, the nasal aperture pillars), although midpalatal suture assessment often remains central to case selection. Methods: A 19-year-old male patient presented with a skeletal Class III tendency, dental crowding, and anterior and bilateral posterior crossbites, accompanied by snoring and breathing difficulties. The patient declined surgical- and miniscrew-assisted RPE. Cone-beam computed tomography (CBCT) scan revealed incomplete midpalatal suture maturation. Based on periodontal evaluation, a conventional tooth-borne RPE was chosen. Pre- and post-expansion CBCT scans were used to evaluate dental, skeletal, and periodontal outcomes. Results: After one year of treatment, bilateral posterior crossbite was successfully corrected. Buccal bone thickness showed a slight reduction only on the upper left first molar (from 1.2 mm to 0.9 mm), without evidence of dehiscence or fenestration. A 2° increase in the dental tipping angle (DTA) was observed on both molars, and the palatal alveolar angle (PAA) increased by 3°. Sutural separation expanded from 0.32 mm to 7.82 mm. The Midpalatal Opening Related to Expander Opening (MORE) factor was 0.54, indicating a predominantly skeletal response. Periodontal health remained stable, and CBCT analysis confirmed increases in intermolar width (from 36.08 mm to 50.02 mm) and palatal maxillary width (from 28.04 mm to 34.5 mm). A reduction in the Pittsburgh Sleep Quality Index (PSQI) from 7 to 3 was observed, though this finding should be interpreted cautiously due to its subjective nature and the absence of objective airway measurements. Conclusions: The present case report suggests that tooth-borne RPE may represent a viable and minimally invasive option for correcting posterior crossbite in carefully selected young adults with incomplete midpalatal suture maturation. However, the findings are limited to a single case with short follow-up and should be regarded as hypothesis-generating rather than conclusive. Full article

Objectives: This study aimed to evaluate maxillary arch width increase in juvenile patients requiring space gain, but without skeletal transverse discrepancies necessitating orthopedic expansion. The comparison focused on the effects of Rapid Maxillary Expansion (RME) using Hyrax expanders and dentoalveolar expansion via Invisalign First. Methods: This retrospective longitudinal study analyzed digital dental models of 38 patients (19 males and 19 females, aged 8 ± 2 years) undergoing maxillary expansion at the Department of Biomedical, Surgical, and Dental Science, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico (Milan, Italy). Patients were divided into two groups: one treated with Hyrax expanders (n = 19) and the other with Invisalign First (n = 19). Intraoral scans were taken before (T0) and after treatment (T1), and measurements were performed using Mimics Materialize 21.0 software. Statistical analysis included t-tests, ANOVA, and regression models to assess differences in maxillary expansion between groups. Results: Both groups showed statistically significant transverse arch increases (p < 0.01). Hyrax achieved greater expansion at the deciduous canine level, while Invisalign showed more at the deciduous molar level. First permanent molar expansion was similar. ICC for reliability was excellent (>0.97). No significant differences in sex or Angle class distribution were observed. Conclusions: Hyrax and Invisalign First both produce measurable maxillary expansion, but they serve distinct roles. While Hyrax expanders provide rapid skeletal expansion, Invisalign First offers a less invasive alternative for dentoalveolar widening with controlled force application. They should not be used interchangeably. Appliance selection must be tailored to the severity and nature of the transverse deficiency. Full article

Background: Midpalatal suture expansion is effective in both growing and adult patients, and Miniscrew-Assisted Rapid Palatal Expansion (MARPE) provides greater skeletal effects and fewer dentoalveolar side effects than traditional expanders. However, asymmetric expansion remains a challenge, often influenced by pre-existing craniofacial asymmetries, appliance design, and suture morphology. In this case report, we describe asymmetric expansion with 3D-guided piezocorticotomy-assisted MARPE and its management with directly printed aligners (DPAs). Methods: A patient with facial asymmetry, a narrow maxillary arch, and multiple dentoalveolar deformities underwent pre-treatment evaluation, including root inclination analysis and CBCT imaging. A MARPE appliance with 3D-guided piezocorticotomy assistance was applied; post-expansion orthodontic treatment was digitally planned and performed with directly printed aligners. Results: During MARPE activation, asymmetric midpalatal suture disarticulation was observed, with greater displacement on the left side due to jackscrew orientation and root proximity. Post-expansion orthodontic correction with DPAs allowed precise root positioning, spatial redistribution, and improved occlusal symmetry. Over 20 months, significant improvements were achieved in midline orientation, axial root inclination, and transverse arch coordination. Conclusions: The reported case underscores the importance of pre-treatment evaluation for asymmetries and careful appliance design in MARPE protocols; in addition, it demonstrates that directly printed aligners, supported by digital planning, can provide accurate and efficient dentoalveolar correction following asymmetric expansion. Full article

Background/Objectives: The nasomaxillary complex is a compound anatomical structure in which the correlation between changes in palatal width and height has been poorly investigated. Methods: A three-year prospective study with 28 patients treated with printed expanders was conducted. Measurements on CBCT images were performed before and after treatment; the width and height parameters were measured on a coronal slice of a CBCT image at the level of the first molars and upper first molar inclination relative to the palatal plane. Results: A significant difference was found between the values measured before and after treatment, including an increase in the measured width parameters and a statistically significant decrease in palatal height (0.75 ± 0.97). The mean change in the upper molar inclination was not significant (tooth 16: 0.60 ± 6.42; tooth 26: 2.19 ± 4.51). The regression analysis did not establish a significant correlation between the expansion of the maxillary occlusal width and palatal height change or a significant correlation between the increase in the upper molar inclination and palatal height change. Conclusions: The use of a printed tooth-borne expander causes predictable and reproducible skeletal changes. It is a feasible treatment option, allowing for precise screw positioning to achieve bodily movement of the teeth and decrease the change in molar inclination. Full article

Objectives: The current study aimed to summarize the current evidence on vertical control provided by the bonded rapid palatal expander (BRPE) in pediatric patient populations within 6 months after expansion. Methods: Relevant studies were screened independently by two researchers from the eight databases MEDLINE (PubMed), Web of Science, SCOPUS, Embase, Cochrane, LILACS (Latin American and Caribbean Health Sciences Literature), LIVIVO and Google Scholar, and supplemented by a manual search of the reference lists from studies selected for full-manuscript reading. Relevant data from lateral cephalograms taken pre- and post-expansion was extracted. A meta-analysis was performed with RStudio and a risk of bias assessment of the included articles was completed. Results: Ten relevant studies were included for data extraction, although most had a high risk of bias. The meta-analysis revealed that within 6-month retention after BRPE treatment, there were (1) slight increases in total (0.83 mm), upper (0.57 mm), and lower (0.70 mm) facial height; (2) minimum change in the palatal plane angulation (−0.01°); (3) minimum change in the occlusal angulation (−0.04°); and (4) minimal mandibular plane angulation changes with 0.01° increase in SN-GoGn angle, 0.71° increase in SN-MP angle, 0.17° increase in FMA, and 0.82° increase in PP-GoGn angle. Conclusions: Current evidence indicates that BRPEs may not control or reduce the vertical dimension significantly within 6 months after expansion. Further high-quality studies, particularly on hyperdivergent patients, are needed to clarify whether bonded expanders offer advantages over traditional banded expanders in management of the vertical dimension. Full article

Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by partial or complete blockage of the upper airway during sleep, leading to disrupted airflow and fragmented sleep. Maxillary expansion has emerged as a promising treatment option, as widening the maxilla can increase nasal airway volume and improve airflow. The treatment options for maxillary expansion include rapid maxillary expansion (RME) for pediatric patients, mini-screw-assisted rapid palatal expansion  (MARPE) for adolescents and adults, surgically assisted rapid palatal expansion (SARPE) for skeletally mature individuals, and distraction osteogenesis maxillary expansion (DOME) for adults with severe maxillary constriction and nasal obstruction.  This comprehensive review explores the role of maxillary expansion in the management of OSA, examining its clinical applications and potential effectiveness as a therapeutic intervention. Full article

Clear aligners (CAs) have emerged as a widely accepted alternative to conventional fixed orthodontic appliances due to their aesthetic appeal, comfort, and removability. Despite their increasing use, the precise biomechanical behavior of CAs—particularly in relation to maxillary arch expansion and torque control—remains incompletely understood. This scoping review aims to synthesize and critically examine the recent body of evidence derived from finite element analysis (FEA) studies investigating the performance of clear aligners in managing transverse discrepancies and controlling tooth movement. It considered studies published up to April 2025. All included FEA studies assumed dental and bone tissues as linearly elastic, homogeneous, and isotropic, unless otherwise specified. Five in silico studies were included, all employing three-dimensional FEA models to assess the influence of various clinical and design parameters, such as aligner thickness, movement sequence, attachment configuration, and torque compensation. The findings consistently show that movement protocols involving alternating activation patterns and specific attachment designs can significantly improve the efficiency of maxillary expansion, while reducing undesired tipping or anchorage loss. Additionally, greater aligner thicknesses were generally associated with increased force delivery and more pronounced tooth displacement. Although FEA provides a powerful tool for visualizing stress distribution and predicting mechanical responses under controlled conditions, the lack of standardized force application and limited clinical validation remain important limitations. These findings underscore the potential of optimized aligner protocols to enhance treatment outcomes, but they also highlight the need for complementary in vivo studies to confirm their clinical relevance and guide evidence-based practice. Full article