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Cephalometric and dental arch changes to Haas-type rapid maxillary expander anchored to deciduous vs permanent molars: a multicenter, randomized controlled trial

Kephalometrische Befunde und Veränderungen im Bereich des Zahnbogens nach forcierter Gaumennahterweiterung mit einer Haas-Apparatur mit Verankerung an Milch- bzw. bleibenden Molaren: Eine multizentrische, randomisierte kontrollierte Studie

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objective

To assess radiographic changes and dental arch changes with Haas-type rapid maxillary expansion (H-RME) anchored to deciduous versus permanent molars in children with unilateral posterior crossbite.

Methods

In all, 70 patients with unilateral posterior crossbite were randomly allocated to group GrE (H-RME on second deciduous molars) or Gr6 (H-RME on first permanent molars) and compared between T0 (before treatment) and T1 (at the RME removal; i.e., 10 months after the end of the activation of the screw). At T0 and T1, cephalometric head films were digitally traced, dental casts were scanned, and rotations of the upper first molars, of the upper central, and of the upper lateral incisors on the models were measured.

Results

Between T0 and T1, the cephalometric analysis showed a significant decrease of the angulation of the upper central incisors to the SN line and to the palatal plane in GrE together with a significant increase of the lower incisors to the mandibular plane (IMPA). The digital dental cast analysis showed that the central and lateral incisors mesiorotated significantly more in GrE than in Gr6. Patients in GrE also showed a statistically significant distorotation of the upper first permanent molars after RME.

Conclusions

GrE showed a significant and spontaneous retraction and alignment of the upper central and lateral incisors compared to Gr6. This is probably due to a more pronounced expansion in the anterior area and more accentuated pressure of the upper lip in GrE. IMPA increased significantly in GrE vs Gr6. GrE also showed a more significant distorotation of the upper first permanent molars compared to Gr6. This is probably due to the design of the H-RME in GrE, where the screw is more anteriorly positioned and the bands are absent on the upper first permanent molars which are, therefore, free to adapt to the best occlusal situation.

Trial registration

ClinicalTrials.gov Identifier NCT02798822.

Zusammenfassung

Zielsetzung

Bestimmt werden sollten die kephalometrischen Veränderungen und die Veränderungen im Zahnbogen bei forcierter Gaumennahterweiterung (GNE; “rapid maxillary extension”, RME) durch Einsatz eines RME(“rapid maxillary expander”)-Expanders vom Haas-Typ, verankert entweder an Milchzahnmolaren oder an bleibenden Molaren bei Kindern mit einseitigem posteriorem Kreuzbiss.

Methoden

Insgesamt 70 Patienten mit einseitigem posteriorem Kreuzbiss wurden randomisiert einer von 2 Gruppen zugeteilt: GrE (H-RME auf den zweiten Milchzahnmolaren) bzw. Gr6 (H-RME auf den ersten permanenten Molaren). Verglichen wurde jeweils zwischen T0 (vor Behandlung) und T1 (bei Entfernung der GNE-Apparatur, d.h. 10 Monate nach Beendigung der Schraubenaktivierung). Zu den Zeitpunkten T0 und T1 wurden kephalometrische Aufnahmen digital durchgezeichnet und Modelle eingescannt. Auf den Modellen vermessen wurden unter anderem die Rotation der oberen ersten Molaren sowie der oberen zentralen und lateralen Schneidezähne.

Ergebnisse

Zwischen den Zeitpunkten T0 und T1 zeigten sich in der Gruppe GrE in der kephalometrischen Analyse eine erhebliche Verringerung des Winkels zwischen den oberen zentralen Schneidezähnen und der SN-Linie und der Gaumenebene und gleichzeitig eine signifikante Erhöhung des Winkels zwischen den unteren Schneidezähnen und der Unterkieferebene (IMPA). Die Analyse der digitalisierten Modelle zeigte in der Gruppe GrE an den zentralen wie an den lateralen Schneidezähnen eine signifikant stärkere Mesiorotation als in der Gruppe Gr6. Die GrE-Patienten wiesen nach forcierter GNE auch eine statistisch signifikante Distorotation der oberen ersten Molaren auf.

Schlussfolgerungen

Im Vergleich mit der Gruppe Gr6 zeigten sich in der Gruppe GrE eine signifikante, spontane Retraktion und ein Alignment der oberen zentralen und lateralen Schneidezähne. Dies liegt wahrscheinlich an einer ausgeprägteren Expansion im vorderen Bereich und einem stärker akzentuierten Druck der Oberlippe in der Gruppe GrE. In der Gruppe GrE vergrößerte sich der Winkel zwischen Mandibularlinie und Schneidezahn (IMPA) im Vergleich Zur Gruppe Gr6 deutlich. Auch die Distorotation der oberen ersten Molaren war in der Gruppe GrE stärker signifikant als in der Gruppe Gr6Dies liegt wahrscheinlich am Design der H-RME in der GrE-Gruppe, d. h. an der weiter vorne positionierten Schraube und daran, dass die oberen ersten permanenten Molaren nicht bebändert waren und sich damit frei in eine optimierte Okklusion entwickeln konnten.

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Authors and Affiliations

  1. Private Practice in Siena, Siena, Italy

    Carmen Cerruto

  2. Division of Orthodontics, Department of Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy

    Alessandro Ugolini & Armando Silvestrini-Biavati

  3. Division of Orthodontics, Department of Medical Biotechnologies, University of Siena, Siena, Italy

    Luca Di Vece & Tiziana Doldo

  4. Division of Orthodontics, Department of Surgical and Morphological Sciences, University of Insubria, Varese, Italy

    Alberto Caprioglio

Authors
  1. Carmen Cerruto
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  2. Alessandro Ugolini
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  3. Luca Di Vece
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  4. Tiziana Doldo
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  5. Alberto Caprioglio
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  6. Armando Silvestrini-Biavati
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Correspondence to Alessandro Ugolini.

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Conflict of interest

C. Cerruto, A. Ugolini, L. Di Vece, T. Doldo, A. Caprioglio, and A. Silvestrini-Biavati state that there are no conflicts of interest.

Ethical statement

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form).

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Informed consent was obtained from all patients included in studies.

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Cerruto, C., Ugolini, A., Di Vece, L. et al. Cephalometric and dental arch changes to Haas-type rapid maxillary expander anchored to deciduous vs permanent molars: a multicenter, randomized controlled trial. J Orofac Orthop 78, 385–393 (2017). https://doi.org/10.1007/s00056-017-0092-2

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