Korean J Orthod.  2020 Mar;50(2):75-85. 10.4041/kjod.2020.50.2.75.

Short-term impact of microimplant-assisted rapid palatal expansion on the nasal soft tissues in adults: A three-dimensional stereophotogrammetry study

• Lee SR
• Lee JW
• Chung DH
• Lee SM

• KMID: 2471868
• DOI: http://doi.org/10.4041/kjod.2020.50.2.75

Abstract

OBJECTIVE
The aim of this study was to evaluate changes in the nasal soft tissues, including movements of landmarks, changes in linear distances, and volumetric changes, using three-dimensional (3D) stereophotogrammetry after microimplant-assisted rapid palatal expansion (MARPE) in adult patients.
METHODS
Facial data were scanned using a white light scanner before and after MARPE in 30 patients. In total, 7 mm of expansion was achieved over a 4-week expansion period. We determined 10 soft tissue landmarks using reverse engineering software and measured 3D vector changes at those points. In addition, we calculated the distances between points to determine changes in the width of the nasal soft tissues. The volumetric change in the nose was also measured.
RESULTS
All landmarks except pronasale and subnasale showed statistically significant movement on the x-axis. Pronasale, subnasale, alar right, and alar left showed significant movement on the y-axis, while all landmarks except subnasale showed significant movement on the z-axis. The alar base width, alar width, and alar curvature width increased by 1.214, 0.932, and 0.987 mm, respectively. The average volumetric change was 993.33 mm³, and the amount of increase relative to the average initial volume was 2.96%.
CONCLUSIONS
The majority of soft tissue landmarks around the nasal region show significant positional changes after MARPE in adults. The nose tends to widen and move forward and downward. The post-treatment nasal volume may also exhibit a significant increase relative to the initial volume. Clinicians should thoroughly explain the anticipated changes to patients before MARPE initiation.

Keyword

MARPE; Soft tissue; Stereophotogrammetry; Nose

MeSH Terms

Adult*
Humans
Nose
Photogrammetry*

Figure

• 

  Figure 1 Microimplant-assisted rapid palatal expansion. A, The microimplant-assisted rapid palatal expansion (MARPE) device (MSE-12; Biomaterials, Seoul, Korea). B, After activation of the MARPE appliance. C, Maxillary transverse deficiency before MARPE. D, Diastema after completion of MARPE.

• 

  Figure 2 Scanning procedure used before and after microimplant-assisted rapid palatal expansion. A, White light scanner (Smart-Scan 3D; Breuckmann, Braunschweig, Germany). B, Scanning position. C, Reverse engineering software (Geomagic Control X 2017; 3D Systems, Seoul, Korea).

• 

  Figure 3 Establishment of reference planes for measurement of nasal soft tissue changes using stereophotogrammetry after microimplant-assisted rapid palatal expansion. A, The horizontal reference plane is defined as the plane passing through the soft tissue nasion (point b) and exocanthion (point a) on both sides. B, The plane perpendicular to the horizontal reference plane and passing through the soft tissue nasion and subnasale (point c) is established as the sagittal reference plane. C, The coronal reference plane is designed such that it is perpendicular to the two existing planes and passed through the soft tissue nasion. D, New coordinate system.

• 

  Figure 4 Locations and definitions of nasal soft tissue landmarks for measurement of nasal soft tissue changes using stereophotogrammetry after microimplant-assisted rapid palatal expansion.A, Alar width (Al Rt to Al Lt); B, alar base width (Ab Rt to Ab Lt); C, inferior width of the nostrils (Ni Rt to Ni Lt); D, alar curvature width (Ac Rt to Ac Lt).See Table 2 for definition of each landmark.

• 

  Figure 5 Superimposition and measurements for evaluation of nasal soft tissue changes using stereophotogrammetry after microimplant-assisted rapid palatal expansion (MARPE). A, Facial scan data before and after MARPE. B, Initial registration. C, Best fit alignment. Additional alignment based on specific regions is achieved (forehead, intercanthal region, and dorsum of the nose). D, Shell to shell three-dimensional deviation maps.

• 

  Figure 6 Measurement of changes in the nose volume using stereophotogrammetry after microimplant-assisted rapid palatal expansion. A, Planes outlining the nasal region. B, Cropped nasal area.

• 

  Figure 7 Displacement of landmarks measured by stereophotogrammetry after microimplant-assisted rapid palatal expansion. The length of the arrows indicates the amount of change (red: x-axis, green: y-axis, blue: z-axis).

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