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Evaluation of surgically assisted rapid maxillary expansion and orthodontic treatment: Effects on dental, skeletal and nasal structures and rhinological findings
Linköping University, Department of Clinical and Experimental Medicine, Maxillofacial Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Sinnescentrum, Department of Oral Surgery UHL.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Surgically Assisted Rapid Maxillary Expansion (SARME) is frequently used to treat skeletal maxillary transverse deficiency (MTD) in skeletally mature and non-growing individuals. Despite previous research in the field, questions remain with respect to the long-term stability of SARME and its effects on hard and soft tissue.

The overall aim of the present doctoral work was to achieve a greater understanding of SARME, using modern image technology and a multidisciplinary approach, with special reference to effects on the hard and soft tissues and respiration. A more specific aim was to evaluate the long-term stability in a retrospective sample of patients treated with SARME and orthodontic treatment and to compare the results with a matched, untreated control group. The studies in this doctoral project are thus based on two different samples and study designs.

The first sample, Study I (Paper I), is a retrospective, consecutive, long-term follow-up material of study models from 31 patients (17 males and 14 females) treated with SARME and orthodontic treatment between 1991 and 2000. The mean pre-treatment age was 25.9 years (SD 9.6) with a mean follow-up time of 6.4 years (SD 3.3). Direct measurements on study models were made with a digital sliding caliper at reference points on molars and canines. To evaluate treatment outcome and long-term stability, the results were compared with study models from an untreated control group, matched for age, gender and follow-up time.

The second sample, Study II (Papers II-IV), is a prospective consecutive, longitudinal material of 40 patients scheduled to undergo SARME and orthodontic treatment between 2006 and 2009.

In Paper II, one patient was excluded because of a planned adenoidectomy. The final sample comprised 39 patients (16 males and 23 females). The mean age at treatment start was 19.9 years (range 15.9 – 43.9). Acoustic rhinometry, rhinomanometry and a questionnaire were used to assess the degree of nasal obstruction at three time-points; pre-treatment, three months after expansion and after completed treatment (mean 18 months).

In Papers III–IV, three patients declined to participate and two had to be excluded because their CT-records were incomplete. The final sample comprised 35 patients (14 males and 21 females). The mean age at treatment start was 19.7 years (range 16.1 – 43.9). Helical CT-images were taken pre-treatment and eighteen months’ post-expansion. 3D models were registered and superimposed at the anterior cranial base. The automated voxel-based image registration method allows precise, accurate measurements in all areas of the maxilla. In Papers II–IV, the treatment groups constituted their own control groups.

The main findings in the retrospective, long-term follow-up study were that SARME and orthodontic treatment normalized the transverse discrepancy and was stable for a mean of 6 years post-treatment. Pterygoid detachment did not entirely eliminate the side effect of buccal tipping of the posterior molars. Relapse is time-related and is most pronounced during the first 3 years after treatment. Thus the retention period should be extended and should be considered for this period. The main rhinological findings in the prospective longitudinal study were that SARME had a shortterm, favourable effect on nasal respiration, but the effect did not persist in the long-term. However, subjects with pre-treatment nasal obstruction reported a lasting sensation of improved nasal function.

SARME and orthodontic treatment had a significant but non-uniform skeletal treatment effect, with significantly greater expansion posteriorly than anteriorly. The expansion was parallel anteriorly but not posteriorly. The lateral tipping of the posterior segment was significant, despite careful surgical separation. No correlation was found between tipping and the patient's age. Furthermore, SARME and orthodontic treatment significantly affected all dimensions of the external features of the nose. The most obvious changes were at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. There were no predictive correlations between the changes. Patients with narrow and constrained nostrils can benefit from these changes with respect to the subjective experience of nasal obstruction. It is questionable whether an alar-cinch suture will prevent widening at the alar-base.

The 3D superimposition applied in Study II is a reliable method, circumventing projection and measurement errors. In conclusion, SARME and orthodontic treatment normalize the transverse deficiency, with long-term stability. SARME has a favourable effect on the subjective perception of nasal respiration. SARME significantly affects dental, skeletal and nasal structures.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. , 104 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1359
Series
Swedish Dental Journal Supplement, ISSN 0348-6672 ; 229
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-91700ISBN: 978-91-7519-666-4 (print)OAI: oai:DiVA.org:liu-91700DiVA: diva2:618631
Public defence
2013-05-31, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-29 Created: 2013-04-29 Last updated: 2013-04-29Bibliographically approved
List of papers
1. Surgically assisted rapid maxillary expansion: long-term stability
Open this publication in new window or tab >>Surgically assisted rapid maxillary expansion: long-term stability
2009 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 31, no 2, 142-149 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to evaluate treatment outcomes and long-term stability in patients treated by surgically assisted rapid maxillary expansion (SARME) and to compare the results with a matched, untreated control group. The sample comprised consecutive study models from 31 subjects (17 males and 14 females) with a mean pre-treatment age of 25.9 years [standard deviation (SD) 9.6]. The mean follow-up time was 6.4 years (SD 3.3). The transverse distances between the maxillary canines and maxillary first molars were measured with digital sliding callipers before treatment (T0), after treatment (T1), and at follow-up (T2). The data were analysed with a Mann-Whitney U, Spearman's rho, and Wilcoxon signed-rank tests. At T1, all posterior crossbites were corrected and the expansions were statistically significant. At T2, despite some reduction in the transverse measurements, the posterior crossbites remained corrected. There were no statistically significant differences between the treatment and control groups at T2 regarding transverse measurements, except for the distance between the mesio-buccal cusp tips of the maxillary first molars. In the treatment group, there was no significant difference in terms of reductions in the transverse dimensions over the short- or long-term, no significant correlations between age or gender and the decrease in transverse dimensions or between the degree of anterior and posterior expansion. There were no significant correlations between the degree of expansion and subsequent post-treatment decrease. The results indicate that SARME normalizes the transverse discrepancies and is stable a mean of 6 years post-treatment. The decreases in the transverse dimensions are most pronounced during the first 3 years post-treatment. 

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-44691 (URN)10.1093/ejo/cjn074 (DOI)77308 (Local ID)77308 (Archive number)77308 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
2. Nasal cavity size, airway resistance, and subjective sensation after surgically assisted rapid maxillary expansion: A prospective longitudinal study
Open this publication in new window or tab >>Nasal cavity size, airway resistance, and subjective sensation after surgically assisted rapid maxillary expansion: A prospective longitudinal study
Show others...
2011 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 140, no 5, 641-651 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: The aims of this study were to measure changes in nasal minimum cross-sectional area and nasal airway resistance after surgically assisted rapid maxillary expansion and to explore a possible correlation with the subjective sensation of nasal obstruction. Methods: Minimum cross-sectional area and nasal airway resistance were measured in 39 consecutive patients treated with surgically assisted rapid maxillary expansion. Subjective nasal obstruction was assessed by a questionnaire at pretreatment and at 3 and 18 months postoperatively. Results: Subjective nasal obstruction had improved significantly by 3 months postoperatively. Minimum cross-sectional area increased and nasal airway resistance decreased. No correlations were found. In subjects with pretreatment subjective nasal obstruction and initially narrow anterior minimum cross-sectional area, there was a significant correlation between a moderate increase in anterior minimum cross-sectional area and improvement in perceived nasal obstruction. Eighteen months postoperatively, no changes were found from pretreatment values for subjective nasal obstruction, minimal cross-sectional area, or nasal airway resistance, and there were no correlations. Subjects with a sensation of nasal obstruction at treatment start reported a lasting significant subjective improvement. Conclusions: The postoperative effects of surgically assisted rapid maxillary expansion did not persist in the long term. No correlation was found between objective and subjective findings. Subjects with pretreatment nasal obstruction, however, reported a lasting sensation of improved nasal function after surgically assisted rapid maxillary expansion.

Place, publisher, year, edition, pages
Elsevier Masson, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-73101 (URN)10.1016/j.ajodo.2010.11.024 (DOI)000296745100017 ()
Note
Funding Agencies|Futurum-The Academy for Healthcare, County Council, Jonkoping Sweden||Medical Research Council of Southeast Sweden||Available from: 2011-12-16 Created: 2011-12-16 Last updated: 2017-12-08
3. Three-dimensional assessment of transverse skeletal changes after surgically assisted rapid maxillary expansion and orthodontic treatment: A prospective computerized tomography study
Open this publication in new window or tab >>Three-dimensional assessment of transverse skeletal changes after surgically assisted rapid maxillary expansion and orthodontic treatment: A prospective computerized tomography study
Show others...
2012 (English)In: American Journal of Orthodontics and Dentofacial Orthopedics, ISSN 0889-5406, E-ISSN 1097-6752, Vol. 142, no 6, 825-833 p.Article in journal (Refereed) Published
Abstract [en]

Introduction: The aim of this prospective longitudinal study was to evaluate transverse skeletal changes after surgically assisted rapid maxillary expansion. The changes were registered by using a 3-dimensional computerized tomography technique based on superimposition on the anterior base of the skull. Methods: The subjects comprised 35 patients (mean age, 19.7 years; range, 16.1-43.9 years). Low-dose, helical computerized tomography images were taken at treatment start and after orthodontic treatment. The 3-dimensional models were registered and superimposed at the anterior cranial base. Results: Surgically assisted rapid maxillary expansion had a significant transverse skeletal treatment effect, significantly greater posteriorly than anteriorly. The expansion was parallel anteriorly, but posteriorly there was significant transverse tipping. Although there was no statistically significant difference between the changes at the corresponding landmarks, the range of standard deviations was marked. Conclusions: The results showed that, for registering transverse skeletal changes after surgically assisted rapid maxillary expansion, 3-dimensional superimposition is a reliable method, circumventing projection and measurement errors. Surgically assisted rapid maxillary expansion had a significant but nonuniform skeletal treatment effect. Despite careful surgical separation, pronounced posterior tipping occurred. No correlation was found between the severity of tipping and the patients age. (Am J Orthod Dentofacial Orthop 2012;142:825-33)

Place, publisher, year, edition, pages
Elsevier Masson, 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87201 (URN)10.1016/j.ajodo.2012.08.015 (DOI)000311635800011 ()
Available from: 2013-01-14 Created: 2013-01-14 Last updated: 2017-12-06
4. Three-dimensional computed tomographic analysis of changes to the external features of the nose after Surgically Assisted Rapid Maxillary Expansion and orthodontic treatment: A prospective longitudinal study
Open this publication in new window or tab >>Three-dimensional computed tomographic analysis of changes to the external features of the nose after Surgically Assisted Rapid Maxillary Expansion and orthodontic treatment: A prospective longitudinal study
Show others...
2013 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Introduction: The aim of this prospective, longitudinal study was toe valuate changes to the external shape and form of the nose after Surgically Assisted Rapid Maxillary Expansion (SARME) and orthodontic treatment. The changes were registered using a three-dimensional (3-D) computer tomography technique, based on superimposition on the anterior base of the skull.

Method: The subjects comprised 35 patients, mean age 19.7 years (16.1-43.9). Lowdose, helical Computerized Tomography (CT) was taken at treatment start and after completed orthodontic treatment, about 18months post-surgery. The 3-D models were registered and superimposed on the anterior cranial base.

Results: There was in general significant widening and overall anterior and inferior displacement of the nasal soft tissue. The changes varied in size and direction. No correlation was found between the initial and final widths of the nose, or between the initial and final widths of the nostrils.

Conclusion: After SARME, the most obvious changes to the external features of the nose  are at the most lateral alar-bases. The difference in lateral displacement profoundly influenced the perception of a more rounded nose. Patients with narrow and constrained nostrils can benefit from these changes. The 3-D superimposition applied in this study is a reliable method, circumventing projection and measurement errors.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-91699 (URN)10.1016/j.ajodo.2013.04.013 (DOI)
Available from: 2013-04-29 Created: 2013-04-29 Last updated: 2014-11-19

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