Korean J Orthod.  2019 Jan;49(1):49-58. 10.4041/kjod.2019.49.1.49.

Comparison of the effects of rapid maxillary expansion and alternate rapid maxillary expansion and constriction protocols followed by facemask therapy

• Onem Ozbilen E
• Yilmaz HN
• Kucukkeles N

• KMID: 2431080
• DOI: http://doi.org/10.4041/kjod.2019.49.1.49

Abstract

OBJECTIVE
The aim of this retrospective study was to evaluate and compare the changes in the pharyngeal airway (PA), maxillary sinus volume, and skeletal parameters after rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) followed by facemask (FM) therapy.
METHODS
The records of 40 patients with skeletal Class III malocclusion due to maxillary retrognathism were collected, and the patients were assigned into two groups. The first group comprised 8 male and 12 female patients (mean age, 10.0 ± 1.1 years) treated using RME/FM for an average of 10 months. The second group comprised 10 male and 10 female patients (mean age, 9.64 ± 1.3 years) treated using Alt-RAMEC/FM for an average of 12 months. Cone-beam computed tomography images acquired before (T0) and after treatment (T1) were evaluated.
RESULTS
Regarding the skeletal effects, significant differences between the groups were the increase in ANS-HRP (perpendicular distance of ANS to the horizontal reference plane, 0.99 mm, p <0.05) in the Alt-RAMEC/FM group and the decrease in PP-SN (palatal plane to Sella-Nasion plane, 0.93°, p < 0.05) in the RME/FM group. Maxillary sinus volumes increased significantly in both the groups, and the increase was statistically significantly higher in the Alt-RAMEC/FM group. Although no significant intergroup differences were observed in PA volumes, both lower (1,011.19 mm3) and total (1,601.21 mm3), PA volume increased significantly in the Alt-RAMEC/FM group.
CONCLUSIONS
The different expansion devices and protocols used with FM therapy do not seem to affect the forward movement of the maxilla and PA volumes. In contrast, the increase in maxillary sinus volume was greater in the Alt-RAMEC/FM protocol.

Keyword

Facemask; Airway; Alternate rapid maxillary expansion and constriction; Cone-beam computed tomography

MeSH Terms

Cone-Beam Computed Tomography
Constriction*
Female
Humans
Male
Malocclusion
Maxilla
Maxillary Sinus
Palatal Expansion Technique*
Retrognathia
Retrospective Studies

Figure

• 

  Figure 1 The flow diagram of patient selection based on the CONSORT statement guidelines. FM, Facemask; RME, rapid maxillary expansion; Alt-RAMEC, alternate rapid maxillary expansion and constriction; 3D, three-dimensional.

• 

  Figure 2 A, Intraoral photo of the Hyrax screw. B, Intraoral photo of the double-hinged expansion screw.

• 

  Figure 3 Skeletal measurements. 1, PP-SN (°); 2, GoMe-SN (°); 3, SNA (°); 4, SNB (°); 5, ANB (°); 6, FMA (°); 7, AVRP (mm); 8, B-VRP (mm); 9, ANS-HRP (mm); 10, PNSHRP (mm); 11, S-Go (mm); 12, ANS-Me (mm); 13, N-Me (mm). PP-SN, The angle between palatal plane and sella-nasion plane; GoMe-SN, the angle between gonion-menton plane and sella-nasion plane; SNA, the angle between sella, nasion and A points; SNB, the angle between sella, nasion and B points; ANB, the angle between A, nasion and B points; FMA, the angle between Frankfort horizontal reference plane and mandibular plane; A-VRP, the distance between A point and the vertical reference plane; B-VRP, the distance between B point and the vertical reference plane; ANS-HRP, the distance between anterior nasal spine point and the horizontal reference plane; PNS-HRP, the distance between posterior nasal spine point and the horizontal reference plane; S-Go, the distance between sella and gonion points; ANS-Me, the distance between anterior nasal spine and menton points; N-Me, the distance between nasion and menton points.

• 

  Figure 4 Three-dimensional reconstruction of the pharyngeal airway (PA). Ch, The point before the last slice where the posterior wall of the pharynx and the nasal septum fuse; CV1, the most anterior and inferior points of the first cervical vertebra; CV2, the most anterior and inferior points of the second cervical vertebra; PNS, posterior nasal spine; HRP, horizontal reference plane.

• 

  Figure 5 Three-dimensional reconstruction of the maxillary sinuses.

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