외과적 술식을 동반한 급속 상악 확장술의 임상 연구

양찬영(Chan-Young Yang),민승기(Seung-Ki Min),오승환(Sung-Hwang Oh),권경환(Kyung-Hwan Kwon),이준(Jun Lee),차재원(Jae-Won Cha) 대한구강악안면외과학회 2005 대한구강악안면외과학회지 Vol.31 No.1

Orthopedic rapid maxillary expansion(RME) has been a common treatment modality used to widen narrow maxillae in young children. However, since more skeletally matured adolescents or adults has closed midpalatal suture, the result of RME was undesirable because of dental tipping with little or no basal skeletal movement and resulted to many other complications. After such treatment, complications often occurred such as alveolar bending, compression of periodontal ligament, extrusion, buccal tipping, and severe relapse. Thus, surgically assisted rapid maxillary expansion(SA-RME) is required, especially for patients over 14 years old, to skeletally release maxillary expansion. We used two methods of maxillary expansion surgery. Surgically assisted rapid maxillary expansion(SA-RME) & surgically assisted posterior segmental expansion(SA-PSE) were used for narrow maxilla. The study was divided into two groups(SA-RME group and SA-PSE group). SA-RME group was consisted of 2 males and 4 females, and the ages of materials ranged from 15 years to 25 years with a mean of 20.2 years. SA-PSE group was consisted of 1 male and 5 females, and the ages ranged from 13 years to 23 years with a mean of 18.7 years. Dental study models were fabricated before starting the expansion and immediately after the expansion was completed. It was fabricated again 1 month later, 3 months later when the expansion device was removed, and 6 months later after the expansion was completed. A repeated measures analysis of variance(ANOVA) test was applied to assess changes between each groups over time. The amount of expansion and the amount of tipping movement each in both groups were compared by using paired t-test and it was also compared between each subjects within the group by using independent t-test. Both SA-RME and SA-PSE group showed stable results, but SA-PSE group showed statical significance in tipping movement of second premolar. We compared 6 patients who recieved SA-RME with 6 patients who received SA-PSE, and appraised the clinical usefulness.

Long-term effects of maxillary skeletal expander treatment on functional breathing

Andrew Combs,Ney Paredes,Ramon Dominguez-Mompell,Martin Romero-Maroto,Boshi Zhang,Islam Elkenawy,Luca Sfogliano,Layla Fijany,Ozge Colak,Ben Wu,Won Moon 대한치과교정학회 2024 대한치과교정학회지 Vol.54 No.1

Objective: To investigate the long-term effects of maxillary skeletal expander (MSE) treatment on functional breathing. Methods: Objective measures of breathing, the peak nasal inspiratory flow (PNIF), and peak oral inspiratory flow (POIF), and subjective measures of breathing, the visual analog scale (VAS) and nasal obstruction symptom evaluation (NOSE) survey, were used to investigate the long-term effects of MSE in functional breathing. Seventeen patients, mean age 19.4 ± 3.9 years treated at the UCLA Orthodontics Clinic were assessed on their functional breathing at 3 timepoints: pre-expansion (T0), post-expansion (T1), and post-orthodontic treatment (T2). Results: Immediately after expansion (T1), all the objective functional breathing values were significantly increased in comparison to T0 (P < 0.05). The VAS total, VAS right and VAS left were significantly lower at T1 in comparison to T0 (P < 0.05). At 26.8 ± 3.9 months after MSE expansion (T2), PNIF total, PNIF right, PNIF left, and POIF were significantly higher when compared to T0 (P < 0.05). Also, VAS total, VAS right and VAS left were significantly lower at T2 when compared to T0 (P < 0.05). Additionally, there was a positive correlation between PNIF and the magnitude of expansion at anterior nasal spine and zygomaticomaxillary point (ZMA). There was a positive correlation between total VAS and the magnitude of expansion at the ZMA. There were no significant changes for the NOSE subjective breathing measurement at all time comparisons. Conclusions: Overall, MSE treatment produces an increased objective and subjective airway improvement that continues to remain stable in the long-term post expansion.

Effectiveness of miniscrew assisted rapid palatal expansion using cone beam computed tomography: A systematic review and meta-analysis

Siddhisaributr Patchaya,Khlongwanitchakul Kornkanok,Anuwongnukroh Niwat,Manopatanakul Somchai,Viwattanatipa Nita 대한치과교정학회 2022 대한치과교정학회지 Vol.52 No.3

Objective: This study aims to examine the effectiveness of miniscrew assisted rapid palatal expansion (MARPE) treatment in late adolescents and adult patients using cone-beam computed tomography (CBCT). Methods: Literature search was conducted in five electronic databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) based on the PICOS keyword design focusing on MARPE. Out of the 18 CBCT screened outcomes, only nine parameters were sufficient for the quantitative meta-analysis. The parameters were classified into three main groups: 1) skeletal changes, 2) alveolar change, and 3) dental changes. Heterogeneity test, estimation of pooled means, publication bias, sensitivity analysis and risk of bias assessment were also performed. Results: Upon database searching, only 14 full-text articles were qualified from the 364 obtained results. Heterogeneity test indicated the use of the random-effects model. The pooled mean estimate were as follows: 1) Skeletal expansion: zygomatic width, 2.39 mm; nasal width, 2.68 mm; jugular width, 3.12 mm; and midpalatal suture at the posterior nasal spine and anterior nasal spine, 3.34 mm and 4.56 mm, respectively; 2) Alveolar molar width expansion, 4.80 mm; and 3) Dental expansion: inter-canine width, 3.96 mm; inter-premolar width, 4.99 mm and inter-molar width, 5.99 mm. The percentage of expansion demonstrated a skeletal expansion (PNS) of 55.76%, alveolar molar width expansion of 24.37% and dental expansion of 19.87%. Conclusions: In the coronal view, the skeletal and dental expansion created by MARPE was of the pyramidal pattern. MARPE could successfully expand the constricted maxilla in late adolescents and adult patients.

Horseshoe Expander의 확장 효과에 관한 연구

정규림,박영국,이영준,김홍석 대한치과교정학회 2000 대한치과교정학회지 Vol.30 No.5

이 연구는 Horseshoe Expander를 이용하여 확장 전과 후의 악구강계의 변화를 분석하고자 시행되었다. 상악궁 확장이 필요한 것으로 진단된 37명을 연구자료로 사용하였다. 완만 상악골 확장술(SME)을 적용한 17명을 대상으로 연구 대상자의 정모 및 측모 두부 방사선 사진과 모형을 확장 전과 후로 채득하였다. 또한, 급속 상악골 확장장치 (RME)를 적용한 13명을 대상으로 확장 후의 치축각의 변화를 Horseshoe Expander군과 비교하였다. 이 자료를 계측, 통계 처리하여 분석한 결과, 다음과 같은 결론을 얻었다. 1.정모 두부 방사전 규격사진 분석에서 양측 상악 중절치의 치근 및 절단연의 중앙점 사이의 거리, 상악 폭경, 비강 폭경이 유의성있는 증가를 보였고, 상하악 폭경은 감소를 보여 결국 삼각형 모양의 확장 양상을 나타냈다. 2.측모 두부 방사선 규격사진 분석에서 McNamara line에 대한 상악 중절치의 거리, 상악깊이, 상악 높이 항목이 증가를 나타냈다. 또한, FH평면에 대한 상악 중절치, 구개평면, 교합평면, 하악 평면의 각도가 증가를 나타냈으나, McNamara line에 대한 하악 중절치의 거리항목은 유의성이 없었다. 3.모형 분석에서, 구개용적, 상악 견치와 제1대구치의 폭경 및 상악궁 길이 항목이 유의성 있게 증가하였고, 교합 접촉점의 감소가 유의성을 나타냈다. 4.상악 제1대구치간 폭경변화(치성 변화)대 상악폭경변화(골격성 변화)가 약 2.2:1의 비율을 보였다. 5.Horseshoe Expander군과 급속 상악골 확장장치군(RME군)의 확장 전,후 치축각 비교에서는, Horseshoe Expander군이 급속 상악골 확장장치군(RME군)보다 상악 제2소구치, 제1대구치에서 더 큰 상관계수를 가짐으로써 협측 경사이동이 적은 것으로 나타났다. 따라서, Horseshoe Expander는 치성 변화가 적고, 급속 상악골 확장장치(RME)에 비하여 협측 경사이동이 적으므로 상악궁 확장에 효과적인 장치로 사료된다. Horseshoe Expander is one of Slow Maxillary Expansion(SME) which aims to accommodate the contra- lateral expansion and midpalatal suture expansion of the palate. The appliance consists of skeleton type screw embedded in split Horseshoe appliance. It is the objectives of the presentation to manifest the changes in dental & craniofacial components subsequent to the application of Horseshoe Expander. The subjects for this study consisted of 32 patients (mean age : 12.7). Frontal, lateral cephalometric headfilm were taken and study casts were fabricated before and after expansion. 24 items were measured, compared preexpansion with postexpansion. Especially, palatal volume was measured by means of "Hydro-measurement method". Tooth axis measurement on the dental casts were made with Universal bevel protractor, and Horseshoe Expander group were compared with RME group. This study of changes to maxillary expansion with Horseshoe Expander revealed the following significant results. 1.Triangular-shaped expansion pattern appeared in frontal cephalometric headfilm. 2.Palatal plane, occlusal plane, mandibular plane and upper incisor to FH increased in lateral cephalometric headfilm. 3.Palatal volume increased significantly. A slight bite opening, reduction of occlusal contact points showed in dental casts. 4.A 2.2 : 1 ratio of the amount of intermolar width in maxilla(orthodontic movement) to maxillary width (orthopedic movement) was determined. 5.Horseshoe Expander group has less buccal tipping tendency than RME group, by taking high correlation coefficients in the upper second premolar and first molar. It was suggested that Horseshoe Expander showed less orthodontic changes, less buccal tipping tendency. In addition, it was effective in maxillary expansion.

Rapid maxillary expansion with corticotomy

김현태(Hyoun Tae Kim),이종철(Jong Chul Lee) 대한구강악안면외과학회 1994 대한구강악안면외과학회지 Vol.20 No.1

上顎骨 擴張術은 1860년 Dr. Angell에 의해 紹介되었다. 그후 열성장된 上顎骨의 擴張을 위해 paratal split osteotomy 등의 外科的 處置가 紹介되어 왔다. 그러나 이러한 處置는 上顎骨 주위 골들의 抵抗 때문에 큰 役割을 하지 못했다. 이러한 抵抗을 克服하기 위해 corticotomy 또는 midpalatal osteomy 등이 紹介되어왔는 바, 저자등은 이러한 術式에 의하여 上顎骨 擴張術의 좋은 結果들을 經驗한 바 이에 紹介하는 바이다. Maxillary expansion has been introduced by Dr. Angell in 1860. Since then, this technique has been performed very usefully in orthodontic field to correct transverse discrepancies. The widening of true apical base of Maxilla in association with palatal split would be considered the most effective and stable way to treat constricted upper jaw and gain available spaces for crowding. Also there are lots of changes in naso-maxillary complex to palatal spliting, which are prerequisite to be understood for clinicians. The responses of surrounding bones and tissues to maxillary expansion were revealed by numerous studies performed by Hass, Isaacson, Murphy, Wertz and so on. But the split of palate in adult may not occur because of skeletal resistances of surrounding bones. Corticotomy or midpalatal osteomy is very useful surgical aid to get palatal split in adult by reducing these resistances. So we are going to discuss about the biomechanical responses and main resistances to palatal split and introduces corticotomy as an excellent surgical aid for maxillary expansion.

Surgically assisted rapid palatal expansion with tent screws and a custom-made palatal expander: a case report

Park, Kang-Nam,Lee, Chang Youn,Park, In Young,Kim, Jwa Young,Yang, Byoungeun Korean Association of Maxillofacial Plastic and Re 2015 Maxillofacial Plastic Reconstructive Surgery Vol.37 No.-

Rapid palatal expansion(RPE) with the tooth-born appliance is not sufficient to apply to the patients with periodontal problem or insufficient tooth anchorage, and it leads to tipping of the anchorage teeth and increasing teeth mobility and root resorption. To avoid these disadvantages, we present the case using palatal screws and custommade palatal expander. A 23-year-old patient underwent surgically assisted rapid maxillary expansion with the Hyrax expansion using 4 tent screws. The study models were used to measure the pre-/-post surgical width of the anterior and posterior dental arches with a digital sliding caliper. In the result, the custom-made palatal expander with 4 tent screws is suitable for delivering a force to the mid-palatal suture expansion. And it is low cost, small sized and simply applied. The results indicated that maxillary expansion with the custom-made palatal anchorage device is predictable and stable technique without significant complications in patients.

전방부 악궁의 협착을 보이는 II급 부정교합 환자의 비수술적 치험례

문하은(Ha-eun Moon),김현민(Hyunmin Kim),박미리내(Mirinae Park),이규형(Gyu-Hyeng Lee),오민희(Min-Hee Oh,),조진형(Jin-Hyoung Cho),이경민(Kyungmin C. Lee) 대한치과교정학회 2021 대한치과교정학회 임상저널 Vol.11 No.3

The treatment of constricted anterior arch in adult patients is challenging for orthodontists because transverse correction of maxillary arch requires surgical approach and transversal change interacts with vertical and sagittal changes correspondingly. This case report introduces a nonsurgical treatment of adult patient with constricted anterior arch and unilateral scissors bite. The anterior maxillary expansion was obtained by rapid palatal expansion (RPE) without the use of mini-implants. Semi-fixed anterior bite plate was used for deep bite correction, and it resulted to spontaneous mandibular expansion. The patient was satisfied with the successful nonsurgical orthodontic treatment which showed favorable occlusion and harmonious facial profile.

Does hyrax expansion therapy affect maxillary sinus volume? A cone-beam computed tomography report

Darsey, Drew M.,English, Jeryl D.,Kau, Chung H.,Ellis, Randy K.,Akyalcin, Sercan Korean Academy of Oral and Maxillofacial Radiology 2012 Imaging Science in Dentistry Vol.42 No.2

Purpose : The aim of this study was to investigate the initial effects of maxillary expansion therapy with Hyrax appliance and to evaluate the related changes in maxillary sinus volume. Materials and Methods : Thirty patients (20 females, 10 males; 13.8 years) requiring maxillary expansion therapy, as part of their comprehensive orthodontic treatment, were examined. Each patient had cone-beam computed tomography (CBCT) images taken before (T1) and after (T2) maxillary expansion therapy with a banded Hyrax appliance. Multiplanar slices were used to measure linear dimensions and palatal vault angle. Volumetric analysis was used to measure maxillary sinus volumes. Student t tests were used to compare the pre- and post-treatment measurements. Additionally, differences between two age groups were compared with Mann-Whitney U test. The level of significance was set at p=0.05. Results : Comparison of pre-treatment to post-treatment variables revealed significant changes in the transverse dimension related to both maxillary skeletal and dental structures and palatal vault angle, resulting in a widened palatal vault (p<0.05). Hard palate showed no significant movement in the vertical and anteroposterior planes. Nasal cavity width increased on a mean value of 0.93mm(SD=0.23, p<0.05). Maxillary sinus volume remained virtually stable. No significant age differences were observed in the sample. Conclusion : Hyrax expansion therapy did not have a significant impact on maxillary sinus volume.

Does hyrax expansion therapy affect maxillary sinus volume? : A cone-beam computed tomography report

Drew M. Darsey,Jeryl D. English,Chung H. Kau,Randy K. Ellis,Sercan Akyalcin 대한구강악안면방사선학회 2012 Imaging Science in Dentistry Vol.42 No.2

Objectives: The aim of this study was to investigate the initial effects of maxillary expansion therapy with Hyrax appliance and to evaluate the related changes in maxillary sinus volume. Materials and Methods: Thirty patients (20 females, 10 males; 13.8 years) requiring maxillary expansion therapy, as part of their comprehensive orthodontic treatment, were examined. Each patient had cone-beam computed tomography (CBCT) images taken before (T1) and after (T2) maxillary expansion therapy with a banded Hyrax appliance. Multiplanar slices were used to measure linear dimensions and palatal vault angle. Volumetric analysis was used to measure maxillary sinus volumes. Student t tests were used to compare the pre- and post-treatment measurements. Additionally, differences between two age groups were compared with Mann-Whitney U test. The level of significance was set at p=0.05. Results: Comparison of pre-treatment to post-treatment variables revealed significant changes in the transverse dimension related to both maxillary skeletal and dental structures and palatal vault angle, resulting in a widened palatal vault (p<0.05). Hard palate showed no significant movement in the vertical and anteroposterior planes. Nasal cavity width increased on a mean value of 0.93 mm (SD=0.23, p<0.05). Maxillary sinus volume remained virtually stable. No significant age differences were observed in the sample. Conclusions: Hyrax expansion therapy did not have a significant impact on maxillary sinus volume.

어린이에서 저속 상악 확장에 따른 골격성, 치아치조성, 기도 변화에 대한 3차원적 평가

김나운,이대우,김재곤,양연미 대한소아치과학회 2023 大韓小兒齒科學會誌 Vol.50 No.2

The aim of this study was to investigate the effects of slow maxillary expansion (SME) on the dentoalveolar, skeletal, upper airway, and maxillary sinus using cone-beam computed tomography (CBCT). Twenty-three orthodontic patients (mean age 8.93 ± 1.61 years) who were treated with maxillary expansion using banded hyrax in the Department of Pediatric Dentistry at Jeonbuk National University Dental Hospital were included. According to the expansion speed applied, they were divided into two groups: SME (12 subjects, mean age 8.92 ± 1.45 years) and rapid maxillary expansion (RME, 11 subjects, mean age 8.94 ± 1.84 years). CBCT were obtained before (T0) and after (T1) the treatment and were analyzed with InVivo5 software (Anatomage, San Jose, CA, USA). Descriptive statistics showed no significant differences between the two groups in age, sex, or skeletal maturity. There were significant increases in maxillary width at the dentoalveolar and skeletal levels for both groups. Upper airway volume revealed a significant increase of 38.59% in the SME group and 28.72% in the RME group. However, there was no significant difference between SME group and RME group in all measurements. This study suggested the efficacy of SME in growing patients. SME was effective in increasing not only dentoalveolar and skeletal measurements but also airway volume. Therefore, pediatric dentists should select an appropriate expansion method considering the physiological aspects of periodontal tissues and discomfort in growing children. 이 연구의 목적은 상악 확장 속도에 따른 치아치조성, 골격성 효과 및 상기도에 대한 효과를 CBCT를 통해 3차원적으로 분석하여 저속 상악 확장의 효과를 확인하는 것이다. 전북대학교 소아치과에서 Banded hyrax를 이용하여 상악 확장을 시행한 23명(평균 8.93 ± 1.61세)의 환자가 포함되었다. 확장 속도에 따라 저속 상악 확장군과 급속 상악 확장군으로 분류되었다. 치료 전후의 치아치조성, 골격성, 기도 부피 변화를 평가하기 위해 치료전(T0)과 치료 종료 및 유지 후(T1)에 촬영한 CBCT를 사용하였다. 상악 확장 결과 두 군모두에서 치아치조성, 골격성 측정 값 및 상기도 부피의 유의한 증가가 관찰되었다. 또한모든 측정 값에서 저속 상악 확장과 급속 상악 확장 간의 유의한 차이를 보이지 않았다. 이연구는 혼합치열기 어린이에서 저속 상악 확장의 효과에 대해 확인하였다. 저속 상악 확장은 치아치조성, 골격성 측정 값 뿐만 아니라 기도 부피, 상악동 기체 부피에서도 유의한 효과를 보였다. 또한, 급속 상악 확장의 효과와 비교하였을 때 유의한 차이를 보이지 않았다. 따라서 소아치과의사는 성장기 어린이의 치주 조직의 생리적 측면, 불편감에 따른 협조도등을 고려하여 급속 상악 확장과 저속 상악 확장 중 적절한 방법을 선택할 수 있을 것이다.