Korean J Orthod.  2021 May;51(3):145-156. 10.4041/kjod.2021.51.3.145.

Midfacial soft tissue changes after maxillary expansion using micro-implant-supported maxillary skeletal expanders in young adults: A retrospective study

• Nguyen H
• Shin JW
• Giap HV
• Kim KB
• Chae HS
• Kim YH
• Choi HW

• KMID: 2515818
• DOI: http://doi.org/10.4041/kjod.2021.51.3.145

Abstract

Objective
The aim of this retrospective study was to assess the midfacial soft tissue changes following maxillary expansion using micro-implantsupported maxillary skeletal expanders (MSEs) in young adults by cone-beam computerized tomography (CBCT) and to evaluate the correlations between hard and soft tissue changes after MSE usage.
Methods
Twenty patients (mean age, 22.4 years; range, 17.6–27.1) with maxillary transverse deficiency treated with MSEs were selected. Mean expansion amount was 6.5 mm. CBCT images taken before and after expansion were superimposed to measure the changes in soft and hard tissue landmarks. Statistical analyses were performed using paired t-test and Pearson’s correlation analysis on the basis of the normality of data.
Results
Average lateral movement of the cheek points was 1.35 mm (right) and 1.08 mm (left), and that of the alar curvature points was 1.03 mm (right) and 1.02 mm (left). Average forward displacement of the cheek points was 0.59 mm (right) and 0.44 mm (left), and that of the alar curvature points was 0.61 mm (right) and 0.77 mm (left) (p < 0.05). Anterior nasal spine (ANS), posterior nasal spine (PNS), and alveolar bone width showed significant increments (p < 0.05). Changes in the cheek and alar curvature points on both sides significantly correlated with hard tissue changes (p < 0.05).
Conclusions
Maxillary expansion using MSEs resulted in significant lateral and forward movements of the soft tissues of cheek and alar curvature points on both sides in young adults and correlated with the maxillary suture opening at the ANS and PNS.

Keyword

Maxillary expansion; Micro-implant-supported maxillary skeletal expander; Soft tissue change

Figure

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  Figure 1 Intraoral photographs of a maxillary skeletal expander (MSE). A, C, Before activation of the MSE. B, Diastema following MSE use. D, After activation of the MSE.

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  Figure 2 OnDemand 3D (CyberMed Inc, Seoul, Korea) voxel-based superimposition on the cranial base. The yellow box was used to determine the area of the cranial base which was the reference for superimposition.

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  Figure 3 Superimposed pre- and post-expansion cone-beam computerized tomography (CBCT) scans following maxillary skeletal expander use (primary CBCT, violet; secondary CBCT, red).

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  Figure 4 The coordinate system consists of three axes (x, y, z) with their origin (0, 0, 0) registered at nasion. 1, nasion; 2 and 3, orbitale (right and left); 4, porion (right). Positive values are to the left, posterior, and superior to the nasion point. FH, Frankfort horizontal.

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  Figure 5 Soft tissue landmarks used in this study. 1 and 2, alar curvature points (right and left); 3, subnasale; 4, soft tissue A point; 5, labrale superius; 6 and 7, cheilion (right and left); 8 and 9, cheek points (right and left; the intersection point of the vertical and horizontal blue lines. The vertical blue line passes through the mid-canthus parallel to the z-axis. The horizontal blue line is perpendicular to the vertical line passing through the alare); A and B, alare (right and left; the most lateral point on each alar contour); C and D, endocanthus (right and left); E and F, exocanthus (right and left); G and H, mid-canthus (right and left).

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  Figure 6 Hard tissue landmarks used in this study. 1 and 2, A point (right and left); 3 and 4, prosthion (right and left); 5 and 6, ectocanine (right and left); 7 and 8, ectomolare (right and left); and 9 and 10, processus zygomaticus (right and left).

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  Figure 7 A, Anterior nasal spine (ANS) and posterior nasal spine (PNS) width after expansion. B, Alveolar width after expansion.

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