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Three-Dimensional Evaluation of Slow Maxillary Expansion with Leaf Expander Vs applied sciences Article 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 Gianguido Cossellu 1,2 , Alessandro Ugolini 3, Matteo Beretta 4, Marco Farronato 1,2 , Alessandro Gianolio 5 , Cinzia Maspero 1,2 and Valentina Lanteri 1,2,* 1 Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, 20100 Milan, Italy; [email protected] (G.C.); [email protected] (M.F.); [email protected] (C.M.) 2 Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy 3 Department of Sciences Integrated Surgical and Diagnostic, University of Genova, 16100 Genova, Italy; [email protected] 4 Private Practice, 15033 Casale Monferrato (AL), Italy; [email protected] 5 Private Practice, 12042 Bra (CN), Italy; [email protected] * Correspondence: [email protected]; Tel.: +39-025-032-0241 Received: 9 April 2020; Accepted: 23 June 2020; Published: 29 June 2020 Abstract: The aim is to evaluate the effects of slow maxillary expansion on maxillary and mandibular arch, using a slow maxillary expander (SME-Leaf Expander) banded on primary second molar. Ninety patients with transverse maxillary deficiency and posterior crossbite were selected. Sixty-nine patients (33 males/36 females; 7.6 1.7 years old) who underwent SME and 21 patients (10 males/ ± 11 females; 7.4 1.2 years old) who were treated with rapid maxillary expander (RME). Digital ± models obtained pre- and post-treatment at appliance removal (9 to 11 months) were processed by means of a 3D scanner (Trios 3, 3Shape D250 laser, Copenhagen, Denmark). Interdental width in both maxilla and mandible were measured with 3 SHAPE Ortho Analyzer. Four Maxillary and four mandibular interdental width were traced and evaluated. The adequate Student’s t-test (dependent or independent) was used to compare intra and intergroups interdental width differences (p < 0.05). The efficacy of the SME was confirmed both on maxillary and mandibular arch. All the maxillary and mandibular interdental widths increased significantly (p < 0.001). The comparison with the RME group showed significant statistical differences between the two treatments with a greater increase in primary first and second intermolar and canine width for the test group (p < 0.001). SME with Leaf Expander produced statistically significant effects for the correction of transverse maxillary deficiencies with a significant indirect effect on the mandibular arch. Keywords: maxillary expansion; palatal expansion; crossbite; digital dentistry; digital orthodontics; 3D imaging; slow maxillary expansion; clinical research 1. Introduction Maxillary transverse hypoplasia is commonly associated with uni- or bilateral posterior crossbite with an incidence ranging from 4% to 20% and, depending on the geographical area, even 50% of the population examined [1–5]. Posterior crossbite can result in many different growth alterations, with asymmetrical condylar positioning, temporomandibular dysfunction and even more severe skeletal and myofunctional alterations [6–8]. Appl. Sci. 2020, 10, 4512; doi:10.3390/app10134512 www.mdpi.com/journal/applsci Appl. Sci. 2020, 10, x FOR PEER REVIEW 2 of 9 Appl. Sci. 2020, 10, 4512 2 of 9 The maxillary deficit does not self-correct during the growth, thus, slow maxillary expansion (SME)The or maxillaryrapid maxillary deficit doesexpansion not self-correct (RME) could during be theperformed growth, with thus, the slow intent maxillary to correct expansion it. As (SME)reported or rapidby several maxillary authors, expansion widening (RME) couldthe maxilla be performed with withmaxillary the intent expansion to correct often it. As reportedleads to byspontaneous several authors, forward widening posturing the and maxilla to spontaneous with maxillary expansion expansion of the often mandible leads to [9–12]. spontaneous This is forwardbecause posturingthe palatal and expansion to spontaneous acts on the expansion balance of of the forces mandible between [9– the12]. tongue This is and because cheek the on palatal lower expansion arch. The actsaction on of the the balance tongue of on forces the betweenmandibular the tongueteeth might and cheek promote on lower the growth arch. The of actionthe mandibular of the tongue dental on thearch mandibular width [12,13]. teeth might promote the growth of the mandibular dental arch width [12,13]. Spontaneous enlargement inin the mandibular dentitiondentition under the influenceinfluence of RME or SME have been reported previouslypreviously [[14–18].14–18]. The LeafLeaf Expander Expander has has been been proposed proposed previously previously in 2016 in by2016 Lanteri by Lanteri et al. [19 et] andal. [19] is now and available is now withavailable two with different two measurementsdifferent measurements of the screw of the (6 sc orrew 9 mm) (6 or and9 mm) with and two with diff twoerent different types of types forces of generatedforces generated by the nickelby thetitanium nickel titanium leaf spring leaf (450 spring or 900 (450 g). or Recently 900 g). Recently the efficacy the of efficacy this new of expanderthis new hasexpander been reported has been byreported the same by authorsthe same in authors pilot studies in pilot based studies on based digital on models digital andmodels postero-anterior and postero- cephalometricanterior cephalometric study. However, study. However, the sample the of sample patients of patients treated was treated limited was tolimited only10 to subjectsonly 10 subjects [20,21]. [20,21].Few data based on 3D noninvasive analysis are available considering the indirect effects of SMEFew on mandibular data based on arch 3D and noninvasive all of those analysis have are been available done with considering a removable the indirect expansion effects plate of SME or a Quadon mandibular Helyx [22 –arch25]. and all of those have been done with a removable expansion plate or a Quad HelyxThe [22–25]. aim of this retrospective study is to quantitatively evaluate the maxillary and mandibular changesThe afteraim theof this SME retrospective treatment with study the is Leaf to quanti Expandertatively in patients evaluate with the maxillarymaxillary archand constrictionmandibular comparedchanges after with the a groupSME treatment of subjects with treated the Leaf with Expander RME. The in null patients hypothesis with maxillary is that the arch Leaf constriction Expander willcompared show lesswith increase a group in of the subjects amount treated of expansion with RM comparedE. The null with hypothesis the RME is group. that the Leaf Expander will show less increase in the amount of expansion compared with the RME group. 2. Materials and Methods 2. Materials and Methods Ninety Caucasian patients, 43 males and 47 females (mean age 7.5 1.5 years), presenting ± withNinety maxillary Caucasian transverse patients, deficiency 43 males and posteriorand 47 females crossbite, (mean were age selected 7.5 ± 1.5 from years), those presenting treated at with the Departmentmaxillary transverse of Biomedical deficiency Surgical and and posterior Dental cro Sciences,ssbite, Universitywere selected of Milan from fromthose June treated 2018 at until the DecemberDepartment 2019. of Biomedical The study Surgical was approved and Dental by the Scie Ethicnces, Committee,University of Fondazione Milan from IRCCS June 2018 Ospedale until Maggiore-Policlinico,December 2019. The Milanstudy (Prot.was approved n◦573). by the Ethic Committee, Fondazione IRCCS Ospedale Maggiore-Policlinico,Inclusion criteria Milan were: (Prot. early n°573). or midmixed dentition with upper primary second molars (E) preserved,Inclusion cervical criteria vertebral were: early stage or 1 throughmidmixed 3 (CVSdenti methodstion with 1–3)upper [26 primary], Angle second Class I ormolars Class (E) II malocclusion,preserved, cervical no previous vertebral orthodontic stage 1 through treatments, 3 (CVS transverse methods maxillary 1–3) [26], hypoplasia, Angle Class digital I or Class records II obtainedmalocclusion, before no activation previous and orthodontic at appliance treatments, removal. transverse Exclusion maxillary criteria were: hypoplasia, presence digital of craniofacial records deformities,obtained before tooth activation extraction and or at surgical appliance treatment, removal. temporomandibular Exclusion criteria were: disorders, presence absence of craniofacial or caries ofdeformities, E. tooth extraction or surgical treatment, temporomandibular disorders, absence or caries of E. Sixty-nine patients (33 males/36 females), mean age 7.6 1.7 years old, treated with SME ± (LeafSixty-nine Expander) patients were selected (33 males/36 according females), to the mean inclusion age 7.6 criteria. ± 1.7 years The appliances old, treated were with banded SME (Leaf by a uniqueExpander) operator were selected on the E. according The expanders to the inclusion presented criteria. a 6 mm The screw appliances (450 g) were with banded an anterior by a armunique till canines;operator no on other the E. orthodontic The expanders treatment presented was applied a 6 mm before screw the (450 removal g) with of thean anterior appliance. arm The till expander canines; wasno other activated orthodontic as described treatment previously was applied by Lanteri before et al.the [ 19removal] (Figure of1 theand appliance. Table1). The expander was activated as described previously by Lanteri et al. [19] (Figure 1–Table 1).
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