Introduction: The aim of this study was to determine the types and prevalence of complications following MARPE protocol at University of the Pacific and to investigate the complication of asymmetry using CBCT analysis. Methods: In the first portion of this study, 97 patients who started treatment prior to July 2020 and who had MARPE expander treatment at the University of the Pacific were included. Chart review and evaluation of progress clinical photographs were used to report the following complications: inflammation, pain, appliance malfunction, broken microscrew, and pulpitis. In the second portion of this study, 77 patients from a private practice orthodontist who started treatment prior to January 2021 were included in this study. The complication of asymmetry was measured using CBCT measurements from T1 (prior to treatment start) and T2 (immediately following MARPE expansion). The change in U6 molar angulation changes was also assessed. Results: It was determined in the first portion of this study that the most common complication was inflammation around the MARPE site, with 82% of the study population exhibiting any severity of inflammation. 3 patients exhibited severe inflammation requiring removal of MARPE. 18% reported pain in the MARPE area. 9 patients exhibited appliance malfunction, 1 patient exhibited broken microscrew, and 1 patient exhibited pulpitis. It was determined in the second portion of this study that 47% of patients exhibited asymmetry greater than 1 mm and the average asymmetry at ANS was 1.47 mm. No correlation was exhibited between amount of asymmetric expansion and the following measures: age, molar inclination, palatal thickness, posterior screw expansion and palatal vault height. 3 Conclusions: Inflammation of the MARPE is the most common complication that can result in early removal of the expander. Other complications such as asymmetry and pain are common as well.

Thesis deals with studying of morphology and variability of palatal shape in patients with hemifacial microsomia. It is congenital facial disorder, manifests in hypoplasia and asymmetry of facial structures. It interfere with part of splanchnocranium,especially manifests at hypoplasia of mandible and facial asymmetry, ears or orbits can be another affects part of the face. For notice morphology of palate was use virtual dental models of superior alveolar arch and palate of patients with HFM. Mean age of patients with HFM was 27,2 years (in range 20,8 - 41,5 years), mean age of control's file was 13,2 years (in range 13,0 - 13,9 years). Every subjects, also from patient's file and from control's file are mens with Czech's nationality. Models were evaluate by methods of geometrics morphometry (DCA, PCA, analysis asymmetry) and multidimensional statistic (Hotteling test, test of homogenity). Palatal shape of patients with HFM and controls is significantly different. Palate of patients with HFM was narrower and shorter in anterior part while wider in posterior lateral part, especially at the left side relative to control's file. We found out by evaluation asymmetry that palate of patients with HFM had the biggest asymmetry at back side of palate, by contrast, the biggest symmetry was at vertical middle line of...

A expansão de maxila cirurgicamente assistida (EMCA) é a modalidade de tratamento que tem como objetivo romper as regiões de reforço maxilar permitindo seu movimento expansivo gradativamente. Tal movimento pode ser realizado às custas de aparelhos dento-suportado, dento-muco-suportado, implanto-suportados ou ósseo-suportado. Os efeitos produzidos pelo tratamento vão desde alterações esqueléticas (aumento da base, cavidade e do espaço aéreo nasais) até inclinações dentárias (principalmente nos dentes de suporte do aparelho expansor), dentre outras. O objetivo desta pesquisa foi avaliar, por meio do Método de Elementos Finitos (MEF), a distribuição das tensões produzidas pela EMCA nas estruturas maxilares utilizando-se aparelho expansor ósseo-suportado. Material e métodos: Foi confeccionado um modelo tridimensional de maxila para simulação da EMCA com osteotomia tipo LeFort I descendente sem degrau, com disjunção pterigomaxilar utilizando um modelo de aparelho ósseo-suportado para o teste com a simulação de abertura de 1mm. Os resultados mostraram maior abertura da maxila na região anterior de incisivos a pré-molar (1 mm) e em menor quantidade (0,6mm) na região de molares. A tensão máxima principal (TMXP) mostrou a concentração de tensões principalmente em toda face palatina da maxila de pré-molar ao túber maxilar. Pela face lateral, ficou mais evidente a TMXP nas região de osso alveolar posterior ao pré-molar, molares e túber, assim como na região de pilar zigomático acima da osteotomia. Pelo plano transversal foi possível observar a transmissão de tensões ao longo das estruturas ósseas mostrando pouca dissipação para as raízes do molar. Enquanto que as forças de compressão (Tensão Mínima Principal), evidenciadas pela tensão mínima principal, se manifestaram nas áreas de pilar zigomático e adjacentes as osteotomias, assim como na áreas de contato do apoio do aparelho com o osso palatino. Tensões de tração e compressão também foram evidenciadas na região de processo pterigoide. A análise de tensão de Von Mises mostrou que a parte que mais sofre estresse é a haste que liga o módulo do aparelho com a plataforma de apoio. Conclusão: Houve maior abertura da maxila na região anterior e as tensões resultantes de forças transmitidas ao osso alveolar dos dentes adjacentes ao aparelho, parecem não ser suficientes para deslocar os dentes. / Surgically assisted maxillary expansion (SARME) is the modality of treatment that aims to weaken the points of maxillary reinforcement allowing its gradual expansion. Such movement can be performed at the expense of dento-supported, dento-muco-supported, implanto-supported or bony-backed devices. The effects produced by the treatment range from skeletal changes (increase of nasal base, cavity and nasal air space) to dental inclinations (mainly in the supporting teeth of the expander apparatus), among others. The objective of the present research was to evaluate the distribution of stress produced by SARME in the maxillary structures using the bone-supported expander apparatus by the Finite Element Method (FEM). Material and methods: A three-dimensional hemi-maxilla model was simulated for SARME with a non-step descending LeFort I osteotomy with pterygomaxillary disjunction using a bone-supported device model for the 1mm aperture simulation test. The results showed a greater opening of the maxilla in the anterior region of the incisors to the premolar (1 mm) and smaller (0.6 mm) in the molar region. The principal maximal stress (TMXP) showed the concentration of the tension forces mainly in all the palatine face of the pre-molar maxilla to the maxillary tuft. Due to the lateral aspect, the TMXP was more evident in the posterior alveolar bone region, the molars and tuber, as well as in the epilating zygomatic region above the osteotomy. From the transversal plane, it was possible to observe the transmission of stress along the bony structures showing little dissipation for the roots of the molar. Meanwhile, the forces of compression (Principal Minimum Tension) evidenced by the principal minimal stress, were manifested in the areas of the zygomatic pillar adjacent to the osteotomies, as well as in the areas of contact of the support of the apparatus with the palatine bone. Tension and compression forces were also evidenced in the pterygoid process region. Von Mises\' stress analysis showed that the most stressed part is the rod connecting the device module to the support platform. Conclusion: There was a greater opening of the maxilla in the anterior region and the resulting forces of tension transmitted to the alveolar bone of the teeth adjacent to the appliance did not seem to be sufficient to displace the teeth.

Nos dias atuais, uma significante parte da população nacional pode apresentar alterações da relação maxilo-mandibular, chamada de má oclusão. A principal alteração do crescimento facial encontrado nos adultos é a deficiência transversal da maxila. A correção desta deficiência é realizada por um procedimento cirúrgico denominado de expansão rápida da maxila cirurgicamente assistida. Estas cirurgias causam uma mudança na atividade muscular, principalmente naqueles músculos responsáveis pelo fechamento mandibular, no qual se destaca o músculo masseter. Estas alterações musculares duram em média 30 dias, quando clinicamente note-se a diminuição da força ou potencial muscular de fechamento mandibular. Verificam-se os efeitos da expansão rápida de maxila sobre os músculos masséteres dos pacientes, avaliando resultados obtidos por eletromiografia de superfície. Realizaram quatro avaliações, no 7° dia pré-operatório e no 7°, 30° e 60° dia pós-operatório, em 20 pacientes, durante a contração máxima voluntária isométrica sobre um rolete de algodão. Comprovou-se que a atividade do músculo apresentou diminuição no 7° dia pós-operatório para 13,7% da sua atividade inicial. Nos 30º e 60º dias após a cirurgia, observou-se a recuperação até 26,7% e 94,9% de sua atividade inicial, respectivamente. / Nowadays, a significant part of the national population presents alterations of the maxilomandibular relationship, denominated bad occlusion. The main alteration of the facial growth found in the adults is the transverse deficiency of maxillary. The correction of this deficiency is accomplished through a surgical procedure denominated. These surgeries cause a change in the muscular activity, mainly in those muscles responsible for closing mandible, in which stands out the masséter muscle. These muscular alterations last 30 days on average, where clinically it is noticed the decrease of the force or muscular potential of closing the jaw. This work evaluates, through the electromyography exam, the effects of the surgical assisted rapid maxillary expansion on the patients\' muscles masseters. Twenty patients were evaluated four times: 7 days before surgery; and 7, 30 and 60 days after surgery. The evaluation was done during the maximum voluntary isometric contraction on a cotton piece. The activity of the muscle diminished 7 days after surgery to 13, 7% of the initial activity. Nevertheless, 30 and 60 days after surgery, there was a recovery to 26, 7 and 94, 9%, respectively.

Orientador: Ary dos Santos Pinto / Resumo: A expansão rápida de maxila assistida cirurgicamente (ERMAC) é uma técnica amplamente aceita para o tratamento das deficiências transversais de maxila em pacientes adultos. Este estudo avaliou as alterações esqueléticas tridimensionais em maxila e mandíbula decorrentes da ERMAC. Um estudo retrospectivo foi realizado com as imagens tomográficas de 20 pacientes adultos submetidos a ERMAC. O método de sobreposição tridimensional da base do crânio e análise de correspondência de forma foram utilizados nas tomografias computadorizadas de feixe cônico (TCFC) obtidas antes da ERMAC (T1) e seis meses após expansão (T2) para avaliar as alterações esqueléticas associadas a ERMAC, a assimetria ocorrida durante a expansão e as alterações de posicionamento mandibular após a ERMAC. A sobreposição por semitransparência e o mapa de cores e vetores foram utilizados para avaliar qualitativamente as alterações esqueléticas após a ERMAC. Oito regiões de interesse na maxila e cinco regiões de interesse na mandibula foram selecionadas para quantificação das diferenças entre os tempos T1 e T2. Testes não paramétricos foram utilizados na análise estatística. As regiões maxilares analisadas apresentaram aumento significativo após a ERMAC, com maiores deslocamentos observados na região de ectocanino e ectomolar. Foi observado assimetria na expansão em até 40% dos pacientes quando avaliado na região de molares e de 25% na região de canino. No entanto, não foi observada associação entre o tipo de mordid... (Resumo completo, clicar acesso eletrônico abaixo) / Surgically assisted rapid maxillary expansion (SARME) is a widely accepted technique for treatment of transversal maxillary deficiency in adult patients. This study assessed the three-dimensional (3D) skeletal changes in maxilla and mandible after SARME. A retrospective study was carried out with tomographic records of 20 patients who underwent SARME. 3D cranial base superimposition and shape correspondence analysis were applied to cone-beam computed tomography (CBCT) scans acquired preoperatively (T1) and six months after SARME (T2) in order to evaluate skeletal changes related to SARME, asymmetry during expansion and mandibular changes after SARME. Semitransparent overlays, color and vectors maps were used to perform a visual qualitative analysis of skeletal changes after SARME. Four bilateral regions of interest (ROI) were selected in the maxilla and five ROI were selected in the mandible to quantify the changes from T1 to T2. Nonparametric tests were used for statistical analysis. Statistically significant increases in all maxillary ROI were observed after expansion. Ectocanine and ectomolar regions presented greater displacements than alar and infrazygomatic regions. Asymmetric expansion was found in 40% of the sample in the Ectomolar region, whereas Ectocanine region showed asymmetry in expansion for 25% of subjects. No association were found between the type of posterior cross bite and the presence of asymmetry in expansions. Changes in mandibular positioning had no bearing on the cephalometric measures assessed after SARME; notwithstanding the mandible had showed backward and downward displacements to the Menton region in 70% of the sample. The Gonion regions showed backward displacements in 60% of the sample, whereas the Condyles showed no predominant movements among the individuals of the sample. Shape correspondence analysis... (Complete abstract electronic access below) / Doutor

A expansão rápida da maxila cirurgicamente assistida tornou-se amplamente utilizada e muito aceitável no tratamento da deficiência maxilar de pacientes adolescentes e adultos. Diversas técnicas cirúrgicas foram propostas ao longo dos anos com o objetivo de solucionar este problema de forma eficiente, com estabilidade dos resultados e baixa morbidade. Controvérsias em relação ao procedimento cirúrgico persistem, principalmente relacionadas a quais osteotomias devem ser realizadas para se obter bons resultados. O objetivo deste trabalho foi avaliar os resultados da expansão ortocirúrgica da maxila realizando osteotomias nas paredes laterais da maxila e na sutura palatina mediana. Foram selecionados dezessete pacientes adultos portadores de deficiência transversa maxilar, com média de idade de 24 anos e 8 meses; todos foram submetidos a exames de tomografia computadorizada convencional e moldagens maxilares previamente ao procedimento cirúrgico e após três meses, no mínimo, do término de ativação e estabilização do aparelho expansor. As medidas do pós-cirúrgico foram confrontadas com as do pré-cirúrgico e os resultados foram comparados e analisados estatisticamente. Foi obtida a expansão desejada clinicamente em todos os pacientes. No entanto, a quantidade de expansão na região de molares foi estatisticamente maior nas áreas referentes aos dentes, enquanto que os resultados obtidos referentes aos caninos se mostraram similares nas três regiões maxilares avaliadas. Quando comparadas às regiões de caninos e molares entre si, a expansão intercaninos foi maior na altura dos forames palatinos e o inverso ocorreu nas regiões de processo alveolar e dentária, nas quais a expansão intermolar foi maior. / Several surgical techniques have been proposed over the years for the treatment of maxillary deficiency aiming at correcting it efficiently, with long-lasting results and low morbidity. Surgically assisted rapid maxillary expansion has found wide acceptance for the treatment of maxillary deficiency in both adolescents and adults. Controversy still remains regarding particularly to which osteotomies are to be done in order to achieve satisfactory outcomes. The author reports on the results of the ortho-surgical maxillary expansion with osteotomies of the maxillary lateral walls and midpalatal suture. Seventeen adults with transverse maxillary deficiency had conventional CT scans and maxillary dental models prior to the operation and also after at least three months from the complete activation and stabilization of the expansion device. The measurements made before and after the operation as well as the final results were assessed and statistical analysis performed. All nineteen patients had the amount of expansion which had been planned. However, the amount of expansion in the molar region was shown to be statistically larger at the teeth while the results at the canines was similar in the three maxillary regions. When comparing the canine and molar regions, the intercanine expansion was greater at the palate foramina region and the opposite was observed with greater intermolar expansion within the regions of the alveolar process and dental.

Statement of the problem. Hypernasality resulting from velopharyngeal insufficiency or incompetency is a resonance disorder that has negative consequences for speech production and intelligibility of afflicted individuals. Purpose. The purpose of this prospective study is to ascertain if a palatal lift prosthesis with a generic silicon velar lamina, termed the Toronto Palatal Lift Prosthesis (TPLP), can assist velopharyngeal valve function to reduce hypernasality in patients. Methods. A prospective study of six patients treated with the TPLP was compared by the outcome measures of nasalance scores, perceptual evaluations, and patient satisfaction to those obtained using a contemporary acrylic palatal lift prosthesis. Results. The six patients had varying degrees of reduction in hypernasality and acceptance of the TPLP. Conclusion. On the basis of this preliminary study on the TPLP it is possible to fabricate a palatal lift prosthesis with a generic silicon velar lamina that reduces hypernasality in select patients.

Statement of the problem. Hypernasality resulting from velopharyngeal insufficiency or incompetency is a resonance disorder that has negative consequences for speech production and intelligibility of afflicted individuals. Purpose. The purpose of this prospective study is to ascertain if a palatal lift prosthesis with a generic silicon velar lamina, termed the Toronto Palatal Lift Prosthesis (TPLP), can assist velopharyngeal valve function to reduce hypernasality in patients. Methods. A prospective study of six patients treated with the TPLP was compared by the outcome measures of nasalance scores, perceptual evaluations, and patient satisfaction to those obtained using a contemporary acrylic palatal lift prosthesis. Results. The six patients had varying degrees of reduction in hypernasality and acceptance of the TPLP. Conclusion. On the basis of this preliminary study on the TPLP it is possible to fabricate a palatal lift prosthesis with a generic silicon velar lamina that reduces hypernasality in select patients.

Background: Historically, many reference lines and planes of the human skull have been used in an attempt to depict the head in a natural head position (NHP) which is a relaxed/balanced position when looking ahead at their eye level. Head position correction has been attempted in fields such as anatomy, art, anthropology, orthodontics, oral and maxillofacial surgery, plastic surgery, and forensics. In orthodontics, oral and maxillofacial surgery, and plastic surgery, corrected head position (CHP) is particularly important for diagnosis of the normality/protrusion/retrusion of the patient’s facial skeleton. Usually a single plane, such as Frankfurt horizontal, is used to correct head position, but its angulation is variable between individuals, because each individual’s anatomy is unique. It has been found previously that the Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism, and these planes averaged -1 to -2 degrees from the true horizontal (HOR, which is a horizontal plane determined as being perpendicular to the earth’s gravitational force) with subjects in NHP. Methods: Craniofacial planes were measured in an Aboriginal Australian sample and in two contemporary samples obtained from Australian orthodontic practices, and the findings were compared with previous studies. Each sample consisted of 40 individuals (20 males and 20 females) with subjects in NHP. The Aboriginal Australian sample was longitudinal (T1, mean age 10 years; T2, mean age 14 years, and T3, mean age 18 years) enabling NHP to be assessed over approximately 8 years. A soft tissue Ear - nose plane (EN plane) was also investigated. Results: NHP reproducibility over 8 years demonstrated a mean of absolute difference of 2.9 degrees, with a range of differences from -7.9 to 8.2 degrees and a standard deviation of differences equal to 3.6 degrees. The Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism with each other, and averaged between 0 and -3 degrees from HOR. On average, EN plane was horizontal but was variable. Conclusions: NHP is not consistently reproducible at the individual level. For hard tissue images, the combined use of NHA, FH, KW plane, and P plane enables prediction of CHP. Additionally, the rectangular shape of the lower orbit - nasal airway region appears to be useful for correcting head position. In facial soft tissue images, EN plane in combination with other visual factors helps to correct head position. Simple geometry enables this head position correction to be performed from any view of the head where relevant landmarks are seen. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346599 / Thesis (D.Clin.Dent.) - University of Adelaide, School of Dentistry, 2008

Background: Historically, many reference lines and planes of the human skull have been used in an attempt to depict the head in a natural head position (NHP) which is a relaxed/balanced position when looking ahead at their eye level. Head position correction has been attempted in fields such as anatomy, art, anthropology, orthodontics, oral and maxillofacial surgery, plastic surgery, and forensics. In orthodontics, oral and maxillofacial surgery, and plastic surgery, corrected head position (CHP) is particularly important for diagnosis of the normality/protrusion/retrusion of the patient’s facial skeleton. Usually a single plane, such as Frankfurt horizontal, is used to correct head position, but its angulation is variable between individuals, because each individual’s anatomy is unique. It has been found previously that the Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism, and these planes averaged -1 to -2 degrees from the true horizontal (HOR, which is a horizontal plane determined as being perpendicular to the earth’s gravitational force) with subjects in NHP. Methods: Craniofacial planes were measured in an Aboriginal Australian sample and in two contemporary samples obtained from Australian orthodontic practices, and the findings were compared with previous studies. Each sample consisted of 40 individuals (20 males and 20 females) with subjects in NHP. The Aboriginal Australian sample was longitudinal (T1, mean age 10 years; T2, mean age 14 years, and T3, mean age 18 years) enabling NHP to be assessed over approximately 8 years. A soft tissue Ear - nose plane (EN plane) was also investigated. Results: NHP reproducibility over 8 years demonstrated a mean of absolute difference of 2.9 degrees, with a range of differences from -7.9 to 8.2 degrees and a standard deviation of differences equal to 3.6 degrees. The Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism with each other, and averaged between 0 and -3 degrees from HOR. On average, EN plane was horizontal but was variable. Conclusions: NHP is not consistently reproducible at the individual level. For hard tissue images, the combined use of NHA, FH, KW plane, and P plane enables prediction of CHP. Additionally, the rectangular shape of the lower orbit - nasal airway region appears to be useful for correcting head position. In facial soft tissue images, EN plane in combination with other visual factors helps to correct head position. Simple geometry enables this head position correction to be performed from any view of the head where relevant landmarks are seen. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346599 / Thesis (D.Clin.Dent.) - University of Adelaide, School of Dentistry, 2008