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OBJECTIVES: To evaluate surgically assisted rapid maxillary expansion (SARME), with osteotomies separating the maxilla into two segments (SARME-2S) and three segments (SARME-3S), on obstruction symptoms and nasal cavity dimensions in patients with maxillary transverse skeletal deficiency (MTSD). MATERIALS AND METHODS: Sixteen patients with MTSD of 7 mm or above were evaluated in each group, for a total of 32 patients. All patients were evaluated pre- and postoperatively up to 10 months after the expander activations. The minimum cross-sectional area (MCA) and the volume of the nasal cavities were identified by acoustic rhinometry. The Nasal Obstruction Symptom Evaluation (NOSE) scale questionnaire was applied. The palate surface area (PSA) was measured, via digitized maxillary models, as a criterion for comparison with the other variables studied. RESULTS: There was no difference between the groups (p = 0.370) and was verified a significant increase in PSA postoperatively. MCA showed a small increase without statistical significance, and together with the volume of the nasal cavities remained constant during the study. NOSE scale scores decreased significantly in the postoperative periods, implying a decrease in nasal obstruction symptoms in both groups. CONCLUSIONS: SARME with two and three segments show similar results, and both may improve nasal obstruction symptoms when present in patients with MTSD. CLINICAL RELEVANCE: SARME, regardless of the chosen surgical technique, should follow the recommendation to correct just the MTSD. While an improvement in nasal breathing is expected, this must be understood as likely, but not certain.
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To determine the association between cephalometric measurements and polysomnographic parameters in Brazilian patients with midface deficiency. This was a primary, clinical, observational, longitudinal, retrospective, analytical, and single-center study. Forty-eight patients with midface deficiency were divided into two groups as follows: those who underwent surgically assisted rapid palatal expansion (SARME) and those who received maxillary advancement (MA). Pre- and post-operative cephalometric and polysomnography measurements were obtained. Pearson's correlation was used to verify the presence of any significant associations between PSG scores and cephalometric measurements. Associations between BMI (Body Mass Index) and AHI (Apnea Hypopnea Index) as well as arousals were observed. In the SARME group, associations between AHI and SNA, UAS and MP-H, arousals and SNA, and Co-A and MP-H were noted. Associations between AHI and Co-A, PoOr-A and MP-H, arousals and UAS, and between minimum saturation of O2 and SNA, SNB, and Co-A were observed in the MA group. This study demonstrates the alterations in the middle third of the face that were related to sleep disturbance. In addition, it shows the associations between the polysomnographic parameters and the cephalometric representations corresponding to the analyzed deformities and transverse or anteroposterior maxillary deficiencies.
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Cefalometria , Face/anormalidades , Face/diagnóstico por imagem , Polissonografia , Adolescente , Adulto , Nível de Alerta , Índice de Massa Corporal , Humanos , Modelos Lineares , Maxila/cirurgia , Pessoa de Meia-Idade , Oxigênio/metabolismo , Técnica de Expansão Palatina , Adulto JovemRESUMO
OBJECTIVE: The aim of the study was to evaluate and correlate masticatory efficiency (ME) and maximum bite force (MBF) in adult individuals of both genders with normal occlusion. DESIGN: The study was conducted in a university research centre. ME and MBF were evaluated in 55 adults (27 men and 28 women) with normal occlusion. All subjects chewed four fuchsin capsules (two on the right and two on the left molar region) for 15 chewing cycles with a 3-min interval between capsules. The concentration of fuchsin in the capsules was determined by spectrophotometry and stratified by gender and chewing side. Bite force (BF) was measured three times on both the left and right molars; the highest value of the three measurements on each side was taken as the MBF. RESULTS: ME was higher in women (right side, 1.17±016µg/mL; left side, 1.20±0.15µg/mL) than in men (right side, 0.92±0.24µg/mL; left side, 0.89±0.24µg/mL). The MBF was higher in men (right side, 632±174N; left side, 627±170N) compared with women (right side, 427±140N; left side, 420±112N). No significant differences in chewing efficiency and BF were found between sides for both genders. CONCLUSIONS: Women showed the highest ME, while men had the highest MBF, with no correlation between these two parameters among genders.
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Força de Mordida , Oclusão Dentária , Mastigação/fisiologia , Músculos da Mastigação/fisiologia , Adolescente , Adulto , Brasil , Feminino , Humanos , MasculinoRESUMO
INTRODUCTION: Surgically assisted rapid palatal expansion (SARPE) is the procedure of choice for treatment of adults with transverse maxillary deficiency greater than 7 mm. There is no consensus about the dentoskeletal effect of an orthodontic retainer on the outcome of SARPE. Our objective was to assess the effectiveness of an orthodontic retainer on dentoskeletal stability. METHODS: Ninety digitized dental casts of 30 adults undergoing SARPE were divided into 2 groups-no retention (n = 15) and retention (n = 15)-and assessed. The dental casts were obtained at 3 checkpoints: (1) 7 days on average before SARPE (preoperatively), (2) 4 months after expansion, and (3) 10 months after expansion was completed. The retention patients received a transpalatal arch just after expander removal, at checkpoint 2. The transpalatal arch was kept for 10 months after completion of the expansion (checkpoint 3 and end of the study). The dental casts were scanned with a Vivid 9i 3D laser scanner (Konica Minolta, Wayne, NJ). The distances measured were premolar and molar intercusp distances, premolar and molar intercervical distances, premolar and molar inter-WALA (Will Andrews and Lawrence Andrews) ridge distances, and palate height at the maxillary first molar. RESULTS: The planned maxillary expansion was within the expected amount (P <0.05). Palatal height at the 4-month checkpoint decreased by 0.79 mm (4.38%) (P <0.001) and again at the 10-month checkpoint by 0.38 mm (0.98%) (P >0.05) but not significantly in both groups. The premolar intercusp distance had a relapse at checkpoint 3 of 1.84 mm (7.18%) (P <0.001) in the no-retention group. Both groups had average relapses of 0.95 mm in the premolar intercervical distances, of 0.88 mm in the premolar inter-WALA ridge distances, of 1.04 mm in the molar intercusp distances, of 0.74 mm in the molar intercervical distances, and of 0.84 mm in the molar inter-WALA ridge distances (P <0.05) at checkpoint 3. CONCLUSIONS: The analysis of relapse in both groups suggests that the use of a transpalatal arch as a retaining device does not improve dento-osseous stability.
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Imageamento Tridimensional/métodos , Maxila/cirurgia , Contenções Ortodônticas , Técnica de Expansão Palatina/instrumentação , Adulto , Dente Pré-Molar/patologia , Arco Dental/patologia , Feminino , Seguimentos , Humanos , Processamento de Imagem Assistida por Computador/métodos , Lasers , Masculino , Modelos Dentários , Dente Molar/patologia , Imagem Óptica/métodos , Desenho de Aparelho Ortodôntico , Osteotomia de Le Fort/métodos , Palato Duro/patologia , Resultado do TratamentoRESUMO
OBJECTIVE: The aim of this study was to classify the opening of the midpalatal suture (MPS) after surgically assisted rapid maxillary expansion (SARME) with disjunction of the pterygomaxillary suture through computed tomography (CT) analysis. STUDY DESIGN: Seventy adults with bilateral transverse deficiency of the maxilla underwent SARME with pterygomaxillary disjunction. Seventy tomographies were performed before the surgery and 70 were performed after the final activation. The Hass appliance was used in 29 patients and Hyrax in 41 patients. The MPS opening was classified into 2 types: type I, total MPS opening from the anterior nasal spine to the posterior nasal spine, and type II, total MPS opening from the anterior nasal spine to the transverse palatine suture, with partial or nonexistent opening posterior to transverse palatine suture. RESULTS: Type I opening was observed in 22 patients (31.5%), and type II opening in 48 patients (68.5%). In 5 cases, the opening posterior to the transverse palatine suture was paramedian. CONCLUSION: Computed tomography allows the evaluation and classification of midpalatal suture openings after SARME with pterygomaxillary disjunction in type I (total) and type II (partial) MPS openings.