Comparison of the skeletal, dentoalveolar, and periodontal changes after Ni-Ti leaf spring expander and rapid maxillary expansion: a three-dimensional CBCT based evaluation.

Publisher: Springer-Verlag Country of Publication: Germany NLM ID: 9707115 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1436-3771 (Electronic) Linking ISSN: 14326981 NLM ISO Abbreviation: Clin Oral Investig

Publication: Berlin : Springer-Verlag
Original Publication: Berlin : Springer, c1997-

Spiral Cone-Beam Computed Tomography*; Male ; Female ; Humans ; Child ; Palatal Expansion Technique ; Cone-Beam Computed Tomography/methods ; Syndrome ; Maxilla/diagnostic imaging

Background: The aim of the present study was twofold:(1) three-dimensionally evaluate the quantitative skeletal and dentoalveolar changes after Ni-Ti leaf spring expander (leaf expander) and rapid maxillary expansion (RME) in mixed dentition patients;(2) analyze the modifications of the buccal alveolar bone plate of the maxillary first permanent molars.
Methods: Patients who underwent CBCT scans before and after maxillary expansion were randomly selected from the records archived at the Department of Biomedical Surgical and Dental Sciences, University of Milan, Italy. Inclusion criteria were the following: no systemic disease or syndromes; maxillary transverse deficiencies (difference between the upper intermolar width and the lower intermolar width of at least 3 mm and/or clinical need based on radiographic evaluation), early mixed dentition with ages between 7 to 10 years old; cervical vertebra maturation stage (CVMS) 1 or 2; no pathologic periodontal status; skeletal class I or II; maxillary expander cemented on the upper second deciduous molars. Exclusion criteria were the following: patients with pubertal or post-pubertal stage of development (CVMS 3-6); late deciduous or late mixed dentition, impossibility to use the second primary molar as anchorage; skeletal class III malocclusion; craniofacial syndromes; patients unable to be followed during the treatment period. Twenty-three patients treated with Leaf Expander, 11 males (mean age 7.8 ± 0.6 years) and 12 females (mean age 8.1 ± 0.8 years), met the inclusion criteria and constituted the case group. Twenty-four (control group) treated with conventional RME, 12 males (mean age 8.4 ± 0.9 years) and 12 females (mean age 8.1 ± 0.7 years). The paired-sample T test was used for intra-group comparison to evaluate the difference between before (T1) and after (T2) maxillary expansion. Independent sample t-test was computed to perform between groups comparison of the skeletal, dentoalveolar, and periodontal changes.
Results: The Leaf Expander and RME group showed a significant increase between T1 and T2 for most of the skeletal and dentoalveolar variables. Concerning the skeletal variables only the RME demonstrated a significant increase at the level of the posterior nasal (PNW) and apical base width (PABW) and maxillary mid-alveolar width (MMW). Despite this, when compare with the Leaf Expander, the RME group exhibited a statistically larger width increase for only two skeletal parameters: PNW (p = 0.03) and MMW (p = 0.02). No significant changes at the periodontal level were found in either group.
Conclusions: According to the current research, the authors confirm the effectiveness of the Leaf Expander and RME to produce similar skeletal and dentoalveolar effects in mixed dentition subjects. Moreover, the devices anchored to deciduous teeth did not reduce the thickness and height of the buccal bone at the level of the maxillary permanent first molars in either of the two groups.
(© 2023. The Author(s).)

Moon H-W, Kim M-J, Ahn H-W, Kim S-J, Kim S-H, Chung K-R et al (2020) Molar inclination and surrounding alveolar bone change relative to the design of bone-borne maxillary expanders: a CBCT study. Angle Orthod 90(1):13–22. (PMID: 3146130610.2319/050619-316.1)
Thilander B, Wahlund S, Lennartsson B (1984) The effect of early interceptive treatment in children with posterior cross-bite. Eur J Orthod 6(1):25–34. https://doi.org/10.1093/ejo/6.1.25. (PMID: 10.1093/ejo/6.1.256583062)
Ciuffolo F, Manzoli L, D’Attilio M, Tecco S, Muratore F, Festa F et al (2005) Prevalence and distribution by gender of occlusal characteristics in a sample of Italian secondary school students: a cross-sectional study. Eur J Orthod 27(6):601–606. (PMID: 1600966810.1093/ejo/cji043)
Thilander B, Lennartsson B (2002) A study of children with unilateral posterior crossbite, treated and untreated, in the deciduous dentition–occlusal and skeletal characteristics of significance in predicting the long-term outcome. J Orofac Orthop 63(5):371–83. (PMID: 10.1007/s00056-002-0210-6)
Lindner A (1989) Longitudinal study on the effect of early interceptive treatment in 4-year-old children with unilateral cross-bite. Scand J Dent Res 97(5):432–438. (PMID: 2617141)
Petrén S, Bondemark L, Söderfeldt B (2003) A systematic review concerning early orthodontic treatment of unilateral posterior crossbite. Angle Orthod 73(5):588–596. (PMID: 14580028)
Lagravere MO, Major PW, Flores-Mir C (2005) Long-term dental arch changes after rapid maxillary expansion treatment: a systematic review. Angle Orthod 75(2):155–161. (PMID: 15825776)
da S. Pereira J, Jacob HB, Locks A, Brunetto M, Ribeiro GLU (2017) Evaluation of the rapid and slow maxillary expansion using cone-beam computed tomography: a randomized clinical trial. Dental Press J Orthod 22(2):61–8. (PMID: 10.1590/2177-6709.22.2.061-068.oar)
McNamara JA, Lione R, Franchi L, Angelieri F, Cevidanes LHS, Darendeliler MA et al (2015) The role of rapid maxillary expansion in the promotion of oral and general health. Prog Orthod 16:33. https://doi.org/10.1186/s40510-015-0105-x. (PMID: 10.1186/s40510-015-0105-x264469314596248)
Luiz Ulema Ribeiro G, Jacob HB, Brunetto M, da Silva PJ, Motohiro Tanaka O, Buschang PH (2020) A preliminary 3-D comparison of rapid and slow maxillary expansion in children: A randomized clinical trial. Int J Paediatr Dent 30(3):349–59. (PMID: 3175562010.1111/ipd.12597)
Bucci R, D’Antò V, Rongo R, Valletta R, Martina R, Michelotti A (2016) Dental and skeletal effects of palatal expansion techniques: a systematic review of the current evidence from systematic reviews and meta-analyses. J Oral Rehabil 43(7):543–564. (PMID: 2700483510.1111/joor.12393)
Lagravère MO, Heo G, Major PW, Flores-Mir C (2006) Meta-analysis of immediate changes with rapid maxillary expansion treatment. J Am Dent Assoc 137(1):44–53. (PMID: 1645699810.14219/jada.archive.2006.0020)
Gautam P, Valiathan A, Adhikari R (2007) Stress and displacement patterns in the craniofacial skeleton with rapid maxillary expansion: a finite element method study. Am J Orthod Dentofac Orthop 132(1):5.e1-11. (PMID: 10.1016/j.ajodo.2006.09.044)
Priyadarshini J, Mahesh CM, Chandrashekar BS, Sundara A, Arun AV, Reddy VP (2017) Stress and displacement patterns in the craniofacial skeleton with rapid maxillary expansion-a finite element method study. Prog Orthod 18(1):17. (PMID: 28603805550221410.1186/s40510-017-0172-2)
Garrett BJ, Caruso JM, Rungcharassaeng K, Farrage JR, Kim JS, Taylor GD (2008) Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod 134(1):8–9.
Ugolini A, Cossellu G, Farronato M, Silvestrini-Biavati A, Lanteri V (2020) A multicenter, prospective, randomized trial of pain and discomfort during maxillary expansion: leaf expander versus hyrax expander. Int J Paediatr Dent 30(4):421–428. (PMID: 3189460310.1111/ipd.12612)
Lanteri C, Beretta M, Lanteri V, Gianolio A, Cherchi C, Franchi L (2016) The leaf expander for non-compliance treatment in the mixed dentition. J Clin Orthod 50(9):552–560. (PMID: 27809214)
Lanteri V, Cossellu G, Gianolio A, Beretta M, Lanteri C, Cherchi C et al (2018) Comparison between RME, SME and Leaf Expander in growing patients: a retrospective postero-anterior cephalometric study. Eur J Paediatr Dent. 19(3):199–204. https://doi.org/10.23804/ejpd.2018.19.03.6. (PMID: 10.23804/ejpd.2018.19.03.630063151)
Lione R, Franchi L, Cozza P (2013) Does rapid maxillary expansion induce adverse effects in growing subjects? Angle Orthod 83(1):172–182. (PMID: 2282747810.2319/041012-300.1)
Nieri M, Paoloni V, Lione R, Barone V, Marino Merlo M, Giuntini V et al (2021) Comparison between two screws for maxillary expansion: a multicenter randomized controlled trial on patient’s reported outcome measures. Eur J Orthod 43(3):293–300. (PMID: 3321565210.1093/ejo/cjaa063)
Lanteri V, Gianolio A, Gualandi G, Beretta M (2018) Maxillary tridimensional changes after slow expansion with leaf expander in a sample of growing patients: a pilot study. Eur J Paediatr Dent 19(1):29–34. https://doi.org/10.23804/ejpd.2018.19.01.05. (PMID: 10.23804/ejpd.2018.19.01.0529569450)
Maspero C, Abate A, Bellincioni F, Cavagnetto D, Lanteri V, Costa A et al (2019) Comparison of a tridimensional cephalometric analysis performed on 3T-MRI compared with CBCT: a pilot study in adults. Prog Orthod 20(1):40. (PMID: 31631241680128510.1186/s40510-019-0293-x)
Cavagnetto D, Abate A, Caprioglio A, Cressoni P, Maspero C (2021) Three-dimensional volumetric evaluation of the different mandibular segments using CBCT in patients affected by juvenile idiopathic arthritis: a cross-sectional study. Prog Orthod [Internet] 22(1):32. https://doi.org/10.1186/s40510-021-00380-6. (PMID: 10.1186/s40510-021-00380-634595615)
Lanteri V, Cavagnetto D, Abate A, Mainardi E, Gaffuri F, Ugolini A et al (2020) Buccal Bone changes around first permanent molars and second primary molars after maxillary expansion with a low compliance Ni-Ti Leaf Spring Expander. Int J Environ Res Public Health 17(23):9104. (PMID: 33291246773021410.3390/ijerph17239104)
Brotto L, Abate A, Cavagnetto D, Fama A, EL Lucarelli D (2021) Early treatment with a slow maxillary niti spring-expander. Narrative review of the literature. Dent Cadmos 89(5):336–44. (PMID: 10.19256/d.cadmos.05.2021.04)
Lanteri V, Farronato M, Ugolini A, Cossellu G, Gaffuri F, Parisi FMR et al (2020) Volumetric changes in the upper airways after rapid and slow maxillary expansion in growing patients: a case-control study. Mater (Basel, Switzerland) 13(10):2239. (PMID: 10.3390/ma13102239)
Lanteri V, Abate A, Cavagnetto D, Ugolini A, Gaffuri F, Gianolio A, et al (2021) Cephalometric Changes following maxillary expansion with Ni-Ti Leaf springs palatal expander and rapid maxillary expander: a retrospective study. Appl Sci [Internet]. 11(12). Available from: https://www.mdpi.com/2076-3417/11/12/5748.
McNamara JAJ, Franchi L (2018) The cervical vertebral maturation method: a user’s guide. Angle Orthod 88(2):133–143. (PMID: 29337631831253510.2319/111517-787.1)
Steiner C (1959) Cephalometrics in clinical practice. Angle Orthod 29(1):8–29. https://doi.org/10.1043/0003-3219(1959)0292.0.CO;2. (PMID: 10.1043/0003-3219(1959)0292.0.CO;2)
Baccetti T, Franchi L, Cameron CG, McNamara JAJ (2001) Treatment timing for rapid maxillary expansion. Angle Orthod 71(5):343–350. (PMID: 11605867)
Cozzani M, Rosa M, Cozzani P, Siciliani G (2003) Deciduous dentition-anchored rapid maxillary expansion in crossbite and non-crossbite mixed dentition patients: reaction of the permanent first molar. Prog Orthod 4:15–22. (PMID: 1288757510.1034/j.1600-9975.2002.02034.x)
Caprioglio A, Bergamini C, Franchi L, Vercellini N, Zecca PA, Nucera R et al (2017) Prediction of Class II improvement after rapid maxillary expansion in early mixed dentition. Prog Orthod 18(1):9. (PMID: 28367605537653910.1186/s40510-017-0163-3)
Miner RM, Al Qabandi S, Rigali PH, Will LA (2012) Cone-beam computed tomography transverse analysis. Part I: normative data. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 142(3):300–7.
Bruder C, Ortolani CLF, de Lima TA, Artese F, Faltin JK (2019) Evaluation of palate area before and after rapid maxillary expansion, using cone-beam computed tomography. Dental Press J Orthod 24(5):40–45. (PMID: 31721945683393610.1590/2177-6709.24.5.040-045.oar)
Park JJ, Park Y-C, Lee K-J, Cha J-Y, Tahk JH, Choi YJ (2017) Skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion in young adults: a cone-beam computed tomography study. Korean J Orthod 47(2):77–86. (PMID: 28337417535963410.4041/kjod.2017.47.2.77)
Dhalberg G (1940) Statistical methods for medical and biological students. Br Med J [Internet]. [cited 2021 Mar 20];2(4158):358. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2179091/.
Brunetto M, da Silva Pereira Andriani J, Ribeiro GLU, Locks A, Correa M, Correa LR (2013) Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: a clinical trial study. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod 143(5):633–44.
Martina R, Cioffi I, Farella M, Leone P, Manzo P, Matarese G et al (2012) Transverse changes determined by rapid and slow maxillary expansion–a low-dose CT-based randomized controlled trial. Orthod Craniofac Res 15(3):159–168. (PMID: 2281243810.1111/j.1601-6343.2012.01543.x)
Wertz RA (1970) Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod 58(1):41–66. https://doi.org/10.1016/0002-9416(70)90127-2. (PMID: 10.1016/0002-9416(70)90127-25269181)
Lemos Rinaldi MR, Azeredo F, Martinelli de Lima E, Deon Rizzatto SM, Sameshima G, Macedo de Menezes L (2018) Cone-beam computed tomography evaluation of bone plate and root length after maxillary expansion using tooth-borne and tooth-tissue-borne banded expanders. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 154(4):504–16.
Akyalcin S, Alexander SP, Silva RM, English JD (2015) Evaluation of three-dimensional root surface changes and resorption following rapid maxillary expansion: a cone beam computed tomography investigation. Orthod Craniofac Res 18(Suppl 1):117–126. (PMID: 2586554010.1111/ocr.12069)
Huynh T, Kennedy DB, Joondeph DR, Bollen A-M (2009) Treatment response and stability of slow maxillary expansion using Haas, hyrax, and quad-helix appliances: a retrospective study. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod 136(3):331–339.
Hicks EP (1978) Slow maxillary expansion. A clinical study of the skeletal versus dental response to low-magnitude force. Am J Orthod 73(2):121–41. (PMID: 34359710.1016/0002-9416(78)90183-5)
Wong CA, Sinclair PM, Keim RG, Kennedy DB (2011) Arch dimension changes from successful slow maxillary expansion of unilateral posterior crossbite. Angle Orthod 81(4):616–623. (PMID: 21306221891973610.2319/072210-429.1)
Cossellu G, Ugolini A, Beretta M, Farronato M, Gianolio A, Maspero C, et al (2020) Three-dimensional evaluation of slow maxillary expansion with Leaf Expander vs. rapid maxillary expansion in a sample of growing patients: direct effects on maxillary arch and spontaneous mandibular response. Appl Sci [Internet]. 10(13). Available from: https://www.mdpi.com/2076-3417/10/13/4512.
Corbridge JK, Campbell PM, Taylor R, Ceen RF, Buschang PH (2011) Transverse dentoalveolar changes after slow maxillary expansion. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod 140(3):317–325.
Di Ventura A, Lanteri V, Farronato G, Gaffuri F, Beretta M, Lanteri C et al (2019) Three-dimensional evaluation of rapid maxillary expansion anchored to primary molars: direct effects on maxillary arch and spontaneous mandibular response. Eur J Paediatr Dent 20(1):38–42. (PMID: 30919643)
Kartalian A, Gohl E, Adamian M, Enciso R (2010) Cone-beam computerized tomography evaluation of the maxillary dentoskeletal complex after rapid palatal expansion. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod 138(4):486–492.
Ugolini A, Cerruto C, Di Vece L, Ghislanzoni LH, Sforza C, Doldo T et al (2015) Dental arch response to Haas-type rapid maxillary expansion anchored to deciduous vs permanent molars: a multicentric randomized controlled trial. Angle Orthod 85(4):570–576. (PMID: 2531403410.2319/041114-269.1)
Rutili V, Mrakic G, Nieri M, Franceschi D, Pierleoni F, Giuntini V et al (2021) Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis. Eur J Orthod 43(3):301–312. (PMID: 3395017810.1093/ejo/cjaa086)
Podesser B, Williams S, Crismani AG, Bantleon H-P (2007) Evaluation of the effects of rapid maxillary expansion in growing children using computer tomography scanning: a pilot study. Eur J Orthod 29(1):37–44. (PMID: 1729001510.1093/ejo/cjl068)
Rungcharassaeng K, Caruso JM, Kan JYK, Kim J, Taylor G (2007) Factors affecting buccal bone changes of maxillary posterior teeth after rapid maxillary expansion. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod 132(4):428.e1–8.
Lo Giudice A, Barbato E, Cosentino L, Ferraro CM, Leonardi R (2018) Alveolar bone changes after rapid maxillary expansion with tooth-born appliances: a systematic review. Eur J Orthod 40(3):296–303. (PMID: 2901677410.1093/ejo/cjx057)
Digregorio MV, Fastuca R, Zecca PA, Caprioglio A, Lagravère MO (2019) Buccal bone plate thickness after rapid maxillary expansion in mixed and permanent dentitions. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod 155(2):198–206.
Oenning AC, Jacobs R, Pauwels R, Stratis A, Hedesiu M, Salmon B (2018) Cone-beam CT in paediatric dentistry: DIMITRA project position statement. Pediatr Radiol 48(3):308–316. (PMID: 2914319910.1007/s00247-017-4012-9)
Larson BE (2012) Cone-beam computed tomography is the imaging technique of choice for comprehensive orthodontic assessment. Am J Orthod Dentofac Orthop Off Publ Am Assoc Orthod its Const Soc Am Board Orthod. 141(4):402 404, 406 passim.
Isaacson K, Thom AR (2015) Orthodontic radiography guidelines. Am J Orthod Dentofac Orthop 147(3):295–296. (PMID: 10.1016/j.ajodo.2014.12.005)

Keywords: Cone beam computed tomography; Leaf Expander; Malocclusion; Rapid maxillary expansion; Slow maxillary expansion

12035-60-8 (titanium nickelide)

Date Created: 20230719 Date Completed: 20230911 Latest Revision: 20230922

20231215

PMC10492880

10.1007/s00784-023-05144-6

37466717