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Skeletal Changes After Rapid Maxillary Expansion and Fixed Orthodontic Treatment: a CBCT Study Chandler Ho

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Skeletal Changes After Rapid Maxillary Expansion and Fixed Orthodontic Treatment: a CBCT Study Chandler Ho Loma Linda University TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works Loma Linda University Electronic Theses, Dissertations & Projects 9-2014 Skeletal Changes after Rapid Maxillary Expansion and Fixed Orthodontic Treatment: A CBCT Study Chandler Ho Follow this and additional works at: http://scholarsrepository.llu.edu/etd Part of the Orthodontics and Orthodontology Commons Recommended Citation Ho, Chandler, "Skeletal Changes after Rapid Maxillary Expansion and Fixed Orthodontic Treatment: A CBCT Study" (2014). Loma Linda University Electronic Theses, Dissertations & Projects. 164. http://scholarsrepository.llu.edu/etd/164 This Thesis is brought to you for free and open access by TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. It has been accepted for inclusion in Loma Linda University Electronic Theses, Dissertations & Projects by an authorized administrator of TheScholarsRepository@LLU: Digital Archive of Research, Scholarship & Creative Works. For more information, please contact [email protected]. LOMA LINDA UNIVERSITY School of Dentistry in conjunction with the Faculty of Graduate Studies ____________________ Skeletal Changes after RME & Fixed Orthodontic Treatment: A CBCT Study by Chandler Ho ____________________ A Thesis submitted in partial satisfaction of the requirements for the degree Master of Science in Orthodontics and Dentofacial Orthopedics ____________________ September 2014 © 2014 Chandler Ho All Rights Reserved Each person whose signature appears below certifies that this thesis in his opinion is adequate, in scope and quality, as a thesis for the degree Master of Science. , Chairperson Kitichai Rungcharassaeng, Professor of Orthodontics Joseph M. Caruso, Professor of Orthodontics V. Leroy Leggitt, Professor of Orthodontics iii ACKNOWLEDGEMENTS I would like to express my appreciation to the individuals who helped me complete this study. I am grateful to the Loma Linda University Department of Orthodontics and the members of my guidance committee. Thank you to Drs. Kitichai Rungcharassaeng, Joseph Caruso and Leroy Leggitt for their advice and comments. I appreciate Mr. Udo Oyoyo for taking care of all of the statistics, and would like to that Loma Linda University for funding this research. This thesis is dedicated to all of my family and friends who have supported me throughout my schooling. I am grateful to my wife, Alison, and my parents, Dr. Ken and Vicki Ho, for their constant love and care. The Lord has blessed me with more than I can imagine, and I look forward to serving Him with all the knowledge, skills, and training I have received. iv CONTENTS Approval Page ................................................................................................................. iii Acknowledgements ......................................................................................................... iv List of Figures ................................................................................................................. vi List of Tables ................................................................................................................. vii List of Abbreviations .................................................................................................... viii Abstract .............................................................................................................................x Chapter 1. Review of the Literature .......................................................................................1 2. Skeletal Changes after Rapid Maxillary Expansion and Fixed Orthodontic Treatment: A CBCT Study ...................................................................................5 Abstract ...........................................................................................................5 Introduction .....................................................................................................6 Methods and Materials ....................................................................................9 Patient Selection........................................................................................9 Results ...........................................................................................................18 Discussion .....................................................................................................30 Conclusions ...................................................................................................37 References .....................................................................................................39 3. Extended Discussion ...........................................................................................42 Study Improvements and Future Directions .................................................42 References .......................................................................................................................44 Appendices A. Pairwise Friedman Comparisons .....................................................................47 v FIGURES Figure Page 1. Four-Banded Hyrax Rapid Maxillary Expansion Appliance .................................10 2. Two-Banded Hyrax Rapid Maxillary Expansion Appliance .................................10 3. Three orthogonal views showing identification of the M1 furcation ....................12 4. Diagram Showing M1 furca and P1 furca, and respective C1 and P2 apex reference points with measurement lines connecting contralateral sides.. ............12 5. T1 coronal image derived from the open-polygon cut ...........................................14 6. Coronal image illustrating how PAA was measured .............................................15 7. Thick slice axial image showing maxillary SE ......................................................16 8. Coronal image illustrating how AE was measured.. ..............................................17 9. Diagram depicting three components of expansion ...............................................30 vi TABLES Table Page 1. Means, standard deviations, and ranges .................................................................18 2. Intraclass Correlation Coefficients (ICC) ..............................................................19 3. Comparison of all parameters among different time intervals (T1, T2 and T3) using Friedman test .........................................................................................20 4. Comparison of all parameters on each tooth (C1, P1, P2 and M1) using Kruskal-Wallis ranks test. ......................................................................................21 5. Comparison of two-banded versus four-banded appliances for C1, P1, P2, and M1 using Mann-Whitney U-test. ....................................................................22 6. Matrix of Kendall’s Tau correlation coefficients for changes in nasomaxillary structures ........................................................................................25 7. Matrix of Kendall’s Tau correlation coefficients for changes at C1 .....................26 8. Matrix of Kendall’s Tau correlation coefficients for changes at P1 ......................27 9. Matrix of Kendall’s Tau correlation coefficients for changes at P2.. ....................28 10. Matrix of Kendall’s Tau correlation coefficients for changes at M1.....................29 11. Comparison of SE, ΔBMW, and ΔID ....................................................................31 12. Summary of orthopedic, alveolar bending, and orthodontic contributions to total expansion at T2 ..........................................................................................31 13. Summary of orthopedic, alveolar bending, and orthodontic contributions to total expansion at T3 ..........................................................................................32 vii ABBREVIATIONS Act Activation Time AE Appliance Expansion App Type of Appliance ART Alveolar Ridge Thickness BMW Buccal Maxillary Width C1 Cuspid CBCT Cone Beam Computed Tomography CT Computed Tomography DICOM Digital Imaging and Communications in Medicine H Ret Hyrax Retention IA Interdental Angle ID Interdental Width Inc1 Central Incisor M1 First Molar MSWA Maxillary Sinus Width Actual MSWT Maxillary Sinus Width Total NFW Nasal Floor Width NW Nasal Width P1 First Premolar P2 Second Premolar PAA Palatal Alveolar Angle PC Ret Pre-CBCT Retention viii PMW Palatal Maxillary Width Rate Rate of Appliance Expansion RME Rapid Maxillary Expansion RPE Rapid Palatal Expansion SE Sutural Expansion T1 Pre-Rapid Maxillary Expansion T2 Post-Rapid Maxillary Expansion T3 Completion of Orthodontic Treatment T Ret Total Retention Time TTT Total Treatment Time ix ABSTRACT OF THE THESIS Skeletal Changes after Rapid Maxillary Expansion and Fixed Orthodontic Treatment: A CBCT Study by Chandler Ho Master of Science, Graduate Program in Orthodontics and Dentofacial Orthopedics Loma Linda University, September 2014 Dr. Kitichai Rungcharassaeng, Chairperson Introduction: The purpose of this study was to use cone-beam computed tomography to quantitatively evaluate the skeletal effects of rapid maxillary expansion and orthodontic treatment, with a specific interest in evaluating whether the skeletal changes achieved by RME will maintain throughout orthodontic treatment. Methods: Thirty consecutive patients (16 boys, 14 girls; mean age, 13.9 ± 1.8 years) who required RME with Hyrax appliances as part of their comprehensive
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