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Early Treatment with a Slow Maxillary Ni–Ti Leaf Springs Expander

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Early Treatment with a Slow Maxillary Ni–Ti Leaf Springs Expander applied sciences Brief Report Early Treatment with a Slow Maxillary Ni–Ti Leaf Springs Expander Massimiliano Vella 1,2, Paolo Cressoni 1,2, Cinzia Tripicchio 1,2, Eleonora Mainardi 1,2 and Luca Esposito 1,2,* 1 Department of Biomedical, Surgical and Dental Sciences, School of Dentistry, University of Milan, 20100 Milan, Italy; [email protected] (M.V.); [email protected] (P.C.); [email protected] (C.T.); [email protected] (E.M.) 2 Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy * Correspondence: [email protected]; Tel.: +39-335-686-9738 Abstract: The aim of this brief report is to analyse the available literature on the clinical outcomes of a particular appliance for slow maxillary expansion that consists of one or more nickel–titanium springs. Materials and methods: The main medical databases (Scopus, Web of Sciences, Pubmed and Google Scholar) were scanned up to January 2020 using “slow maxillary expan*”, “slow palatal expan*”, “leaf expander” and “NiTi Palatal Expander” as keywords. Skeletal changes in the maxilla after expansion with the Leaf Expander (L.E.) or similar appliances were taken into consideration while reviewing relevant manuscripts. The review focuses on the comparison between the L.E. and conventional expanders (i.e., Haas and Hyrax) regarding the increase in both the distance between the palatal cusps of the upper first molars and the distance between the palatal cusps of the upper second deciduous molars, as well as the increment of nasal structures and pain connected to expansion procedures. Results: Bibliographic research retrieved 32 articles that were considered eligible for the present study. The limited number of articles currently available in international medical databases is allegedly partly due to the fact that these expanders are currently produced by only one patent holder company, which affects its diffusion. Conclusion: Despite the reduced number of published articles, due to the recent introduction of the L.E. device, most of the authors have found that the Citation: Vella, M.; Cressoni, P.; effects of the L.E. device are clinically and radiographically comparable to those achievable with the Tripicchio, C.; Mainardi, E.; Esposito, L. Early Treatment with a Slow rapid palatal expander. Maxillary Ni–Ti Leaf Springs Expander. Appl. Sci. 2021, 11, 4541. https:// Keywords: maxillary hypoplasia; maxillary expansion; slow palatal expansion; cross-bite; digital doi.org/10.3390/app11104541 orthodontics Academic Editor: Dorina Lauritano Received: 19 April 2021 1. Introduction Accepted: 11 May 2021 Transverse maxillary hypoplasia is one of the most frequent problems in interceptive Published: 17 May 2021 orthodontics and one of the most studied topics in orthodontics. This condition is frequently related to as unilateral or bilateral cross-bite and/or antero-superior crowding. Posterior Publisher’s Note: MDPI stays neutral cross-bite is a common malocclusion in children with deciduous or mixed dentition with with regard to jurisdictional claims in a prevalence between 8% and 22% [1]. Frequently, transverse deficit is also associated published maps and institutional affil- with a lateral shift of the mandible and/or a space deficit involving superior permanent iations. canines, raising the risk of impacted canines. Even if cross-bite occurs in 6–30% of the general population, spontaneous resolution is very low (0–9%) despite the elimination of oral habits and other etiological factors [2–5]. Maxillary expansion is considered the gold standard to treat this type of malocclusion. It can be achieved using different types of Copyright: © 2021 by the authors. appliances depending on the clinical defects that have to be treated [6–8]. The possibility Licensee MDPI, Basel, Switzerland. to achieve palatal expansion decreases with age, so this treatment is to be executed as This article is an open access article soon as possible, or until the median palatal suture remains fibrous. The suture starts to distributed under the terms and obliterate at around 14–16 years old, and past 13–14 years in women and 15–16 years in conditions of the Creative Commons men it is difficult to achieve orthopaedic expansion. If maxillary expansion is executed Attribution (CC BY) license (https:// with proper timing, it results in a fast, predictable and minimally invasive treatment. There creativecommons.org/licenses/by/ are several orthodontic appliances leading to a maxillary expansion, which differentiate 4.0/). Appl. Sci. 2021, 11, 4541. https://doi.org/10.3390/app11104541 https://www.mdpi.com/journal/applsci Appl. Sci. 2021, 11, x FOR PEER REVIEW 2 of 11 Appl. Sci. 2021, 11, 4541 2 of 10 is executed with proper timing, it results in a fast, predictable and minimally invasive treatment. There are several orthodontic appliances leading to a maxillary expansion, which differentiate themselves for three main reasons: (a) patient’s age (with deciduous, mixed,themselves or forpermanent three main dentition); reasons: (a)(b) patient’s type ageof applied (with deciduous, force (light/orthodontic mixed, or permanent or heavy/orthopaedic);dentition); (b) type of and applied (c) time force of (light/orthodontic force applications or (continuous/discontinuous). heavy/orthopaedic); and (c) timeThe mainof force difference applications concerns (continuous/discontinuous). the type of resulting expansion: The main Rapid difference Maxillary concerns Expansion the type (RME)of resulting or Slow expansion: Maxillary Rapid Expansion Maxillary (SME) Expansion [9–11]. (RME) or Slow Maxillary Expansion (SME)RME [9– 11is]. the gold standard for the treatment of posterior cross-bite because the openingRME of isthe the median gold standard palatal forsuture the treatmentand the maxillary of posterior transverse cross-bite diameter because is the increased opening [12–15].of the median The main palatal disadvantages suture and of the RME maxillary are discomfort transverse and diameter pain for is the increased young patient [12–15]. andThe the main need disadvantages for compliance of RME by parents are discomfort and patients and pain together for the for young the activation patient and of the the appliance.need for compliance In the literature, by parents among and early patients orthodontics together treatments for the activation RME is ofconsidered the appliance. one ofIn the the most literature, painful among therapies early in orthodontics terms of symptoms treatments reported RME is by considered patients (up one to of 98%) the most[16– 18].painful Pain therapiescould be related in terms to ofrapid symptoms expansio reportedn protocol, by patientsbecause the (up expressed to 98%) [16 force–18]. could Pain reachcould up be to related 10 lbs to for rapid each expansion screw activation protocol, (0.2 because or 0.25 the mm) expressed [19]. force could reach up to 10 lbsSince for each1970, screw several activation authors (0.2 have or 0.25 suggested mm) [19 ].that slow expansion is effective in openingSince the 1970, mid-palatal several authors suture have in suggested growing thatpatients, slow expansion thereby isreducing effective inpain opening and discomfort.the mid-palatal Some suture studies, in growingincluding patients, that of La therebynteri et reducing al. [20], showed pain and that discomfort. slow maxillary Some expansionstudies, including through that a nickel–titanium of Lanteri et al. [20expander], showed may that also slow have maxillary orthopaedic expansion effects through in deciduousa nickel–titanium or mixed expander dentition. may Studies also haveto date orthopaedic that evaluate effects nickel–titanium in deciduous maxillary or mixed dentition. Studies to date that evaluate nickel–titanium maxillary expanders are few in expanders are few in number [21,22] and the most of them are focused “on the memory number [21,22] and the most of them are focused “on the memory screw appliance” [23]. screw appliance” [23]. A nickel–titanium expander is able to exert a seamless, light and A nickel–titanium expander is able to exert a seamless, light and continuous force, thus continuous force, thus producing maxillary expansion while maintaining tissue integrity producing maxillary expansion while maintaining tissue integrity [24,25] during midpalate [24,25] during midpalate suture remodelling [7,26,27]. suture remodelling [7,26,27]. The characteristics of the reactivable and pre-activated NiTi leaf spring expanders The characteristics of the reactivable and pre-activated NiTi leaf spring expanders are are as follows: as follows: Leaf Expander Leaf Expander The L.E. is an orthodontic appliance first constructed in 2013 by the development of The L.E. is an orthodontic appliance first constructed in 2013 by the development a previous appliance, E.L.A (Espansore Lento Ammortizzato) [20], at the Centre of of a previous appliance, E.L.A (Espansore Lento Ammortizzato) [20], at the Centre of BioresearchBioresearch Leone Leone in in Sesto Sesto Fiorentino, Fiorentino, Flor Florence,ence, Italy. Italy. The The L.E. L.E. has has similar similar features features to toa conventionala conventional rapid rapid palatal palatal expa expander,nder, but but instead instead of of the the central central screw, screw, it it has has a a double nickel–titaniumnickel–titanium leafleaf springspring (Figure (Figure1) which1) which returns returns to its originalto its original shape during shape deactiva- during deactivation,tion, resulting resulting in calibrated in calibrated
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