Skeletal, dental and facial aesthetic changes following anterior maxillary segmental distraction by tooth-borne device in patients with cleft lip and palate.

The structural process of bone and periodontal ligament (PDL) remodeling during long-term orthodontic tooth movement (OTM) has not been satisfactorily described yet. Although the mechanism of bone changes in the directly affected alveolar bone has been deeply investigated, detailed knowledge about specific mechanism of PDL remodeling and its interaction with alveolar bone during OTM is missing. This work aims to provide an accurate and user-independent analysis of the alveolar bone and PDL remodeling following a prolonged OTM treatment in mice. Orthodontic forces were applied using a Ni-Ti coil-spring in a split-mouth mice model. After 5 weeks both sides of maxillae were scanned by high-resolution micro-CT. Following a precise tooth movement estimation, an extensive 3D analysis of the alveolar bone adjacent to the first molar were performed to estimate the morphological and compositional parameters. Additionally, changes of PDL were characterized by using a novel 3D model approach. Bone loss and thinning, higher connectivity as well as lower bone mineral density were found in both studied regions. Also, a non-uniformly widened PDL with increased thickness was observed. The extended and novel methodology in this study provides a comprehensive insight about the alveolar bone and PDL remodeling process after a long-duration OTM. 

Periodontal ligament and alveolar bone remodeling during long orthodontic tooth movement analyzed by a novel user-independent 3D-methodology

<h2>Abstract</h2> Maxillary transverse deficiency presents challenges in orthodontic treatment, affecting approximately 4-17% of the population and leading to various malocclusions and facial imbalances. Traditional treatments like Rapid Palatal Expander (RPE) have been effective, particularly in younger patients, but are associated with drawbacks and limitations, especially in non-growing individuals. Miniscrew-assisted rapid palatal expansion (MARPE) has emerged as a viable, safe, and cost-effective alternative for late adolescents and adults. Over the past decade, the MARPE has been widely used, leading to substantial clinical data. This narrative review aimed to revisit the crucial aspects related to treatment success, contributing factors, and various designs and protocols for MARPE. The MARPE designs, categorized as pure bone-borne, tissue bone-borne, and tooth bone-borne types, were compared along with their expansion patterns and the clinical implications were discussed. This review also focused on the long-term stability of MARPE and its potential complications. 

Critical issues concerning miniscrew-assisted rapid palatal expanders: A narrative review

This study aims to assess the short- and long-term changes in the upper airway and alar width after mini-implant -assisted rapid palatal expansion (MARPE) in nongrowing patients.Five electronic databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) were searched up to 2 August, 2023 based on the PICOS principles. The main outcomes were classified into three groups: 1) nasal cavity changes, 2) upper airway changes and 3) alar changes. The mean difference (MD) and 95% confidence intervals (CI) were used to assess these changes. Heterogeneity tests, subgroup analyses, sensitivity analyses, and publication bias were also analyzed.Overall, 22 articles were included for data analysis. Nasal cavity width (WMD: 2.05 mm; 95% CI: 1.10, 3.00) and nasal floor width (WMD: 2.13 mm; 95% CI: 1.16, 3.11) increased significantly. While palatopharyngeal volume (WMD: 0.29 cm3, 95% CI: -0.44, 1.01), glossopharyngeal volume (WMD: 0.30 cm3, 95% CI: -0.29, 0.89) and hypopharyngeal volume (WMD: -0.90 cm3; 95% CI: -1.86, 0.06) remained unchanged, nasal cavity volume (WMD: 1.24 cm3, 95% CI: 0.68, 1.81), nasopharyngeal volume (MD: 0.75 cm3, 95% CI: 0.44, 1.06), oropharyngeal volume (WMD: 0.61 cm3, 95% CI: 0.35, 0.87), and total volume of the upper airway (WMD: 1.67 cm3, 95% CI: 0.68, 2.66) increased significantly. Alar width (WMD: 1.47 mm; 95% CI: 0.40, 2.55) and alar base width (WMD: 1.54 mm; 95% CI: 1.21, 1.87) also increased.MARPE can increase nasal cavity width, nasal cavity volume, nasopharyngeal volume and oropharyngeal volume for nongrowing patients, but has no significant effect on hypopharyngeal volume. In addition, the alar width also increased. However, the studies included in this meta-analysis were mainly retrospective, nonrandomized and small in number, so the findings should be interpreted with caution and high-quality RCTs need to be studied. 

The short- and long-term changes of upper airway and alar in nongrowing patients treated with Mini-Implant Assisted Rapid Palatal Expansion (MARPE): a systematic review and meta-analysis

Surgery-mediated acceleration of orthodontic tooth movement (SAOTM) has been proven effective for decades. Research has confirmed that surgical approaches play an important role in adult patients with a short orthodontic treatment time. The mechanism of SAOTM involves short-term acceleration of localized hard and soft tissue remodeling, known as the regional acceleratory phenomenon. However, no relevant review on the biological mechanism of SAOTM has been performed to date. The proposed biological mechanism of acceleration of OTM involves the participation of various cells, cytokines, and signaling pathways. We herein review the relevant literature and summarize the biological mechanism of SAOTM to provide new insights for further research on acceleration of OTM.

https://doi.org/10.1177/03000605221123904

Biological mechanism of surgery-mediated acceleration of orthodontic tooth movement: A narrative review

OBJECTIVES
To compare skeletal and dentoalveolar changes of miniscrew-assisted rapid palatal expansion (MARPE) according to the length of the miniscrews.


MATERIALS AND METHODS
This two-arm parallel-randomized controlled trial included 32 adult patients aged 19-35 years who received orthodontic treatment with MARPE. Patients were allocated to two groups, group long (L) and short (S), through block randomization according to the length of the miniscrews installed in MARPE. Cone-beam computed tomography was performed before expansion and after removal of the MARPE; superimposition of the images was conducted. The primary outcome included the amount of bone expansion and the change in the inclination of the anchorage teeth. The secondary outcome included the success rate of midpalatal suture opening and stability of the miniscrews. Blinding was performed during outcome assessment.


RESULTS
The final sample comprised 31 patients. There was no significant difference in patient characteristics between group L (n = 16) and group S (n = 15). The change in the width of the processus zygomaticus (P = .010) and ectocanine (P = .001) was significantly higher in group L. A significantly higher success rate of the posterior miniscrews was seen in group L (P = .024). There was no statistically significant difference in the success rate of suture separation or change in tooth inclination. Notable complications were not reported.


CONCLUSIONS
MARPE with longer miniscrews can increase the amount of expansion of the maxillary basal bone and canine alveolar bone. Although it also aided in miniscrew stability, it did not guarantee successful midpalatal suture separation.

/pdf/skeletal-and-dentoalveolar-effects-of-miniscrew-assisted-798peap0.pdf

Skeletal and dentoalveolar effects of miniscrew-assisted rapid palatal expansion based on the length of the miniscrew: a randomized clinical trial.

Accelerated tooth movement can be achieved using micro-osteoperforations (MOPs) to stimulate regeneration of the alveolar bone during minimally invasive surgical trauma. However, there is currently no standardized protocol and limited reports regarding the side effects of MOPs based on biological evidence. This study sought to evaluate the biological effects of the number of MOPs on orthodontic tooth movement (OTM) and the potential risk for root resorption. Male CD1 mice were divided into 4 groups based on the number of MOPs, as follows: Sham; 0MOP+OTM; 2MOP+OTM; and 4MOP+OTM groups. Tooth movement distance and the number of osteoclasts were higher whereas bone volume and trabecular number were lower in the 4MOP+OTM group compared to those of the 0MOP+OTM group. Immunofluorescent assay analysis indicated that the 4MOP+OTM group was positively associated with rapid cementum regeneration and periodontal ligament tissue formation. Our findings revealed that the MOP procedure affected tooth movement and did not significantly contribute to root resorption, whereas it may promote constitutive activation of cementogenesis.

Effect of the Number of Micro-Osteoperforations on the Rate of Tooth Movement and Periodontal Response in Mice

Objective Maxillary anterior segmental distraction osteogenesis (MASDO) for cleft and palate patients is the alternative treatment option to correct malocclusion with maxillary arch deficiency and severe crowding. After MASDO, prosthetic considerations are crucial for patients with cleft lip and palate because it is related to facial esthetics and occlusal function. The objectives of this study were to investigate the final restoration type for created alveolar space by MASDO. Methods Thirteen patients with cleft lip and palate who underwent MASDO and orthodontic treatment from the years 2000 to 2010 in Yonsei University were examined. Final restorations are classified as dental implants, conventional prosthesis, and orthodontic space closure. The relationship between the distracted areas and final restoration type was investigated. The authors evaluated lateral cephalograms obtained at predistraction osteogenesis (pre-DO; T1), postdistraction osteogenesis (post-DO; T2), and debond (T3), and measured changes from T1 to T2 and from T2 to T3. Results There was no significant difference of final restoration percentage of dental implants, conventional prosthesis, and space closure with orthodontic treatment. However, dental implants and conventional prostheses were applied more frequently in the posterior area and in the anterior area, respectively. The relapse rate was observed as 36.7% and 22.4% in the values of N-A distance and ANB angulation in T2-T3 stage. Conclusion The MASDO site should be decided, based on final restoration goal. Among the created alveolar spaces, implants were applied mainly to the posterior site and the conventional prostheses were mostly restored to the anterior site. For space closure by orthodontic approach, the area could be both anterior or posterior.

How Is the Created Alveolar Space Finally Restored After Maxillary Anterior Segmental Distraction Osteogenesis

Effect of a miniscrew surgical guide on the success rate and root proximity of orthodontic miniscrews: A retrospective cohort study

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Skeletal and dentoalveolar effects of miniscrew-assisted rapid palatal expansion based on the length of the miniscrew: a randomized clinical trial.

Effect of the Number of Micro-Osteoperforations on the Rate of Tooth Movement and Periodontal Response in Mice

How Is the Created Alveolar Space Finally Restored After Maxillary Anterior Segmental Distraction Osteogenesis

Effect of a miniscrew surgical guide on the success rate and root proximity of orthodontic miniscrews: A retrospective cohort study