Photographic analysis of orofacial soft tissue alterations related to rapid maxillary expansion in pediatric patients

Maxillary transverse deficiency is widely recognized as one of the most common skeletal issues in orthodontics, and rapid maxillary expansion (RME) is commonly employed as a treatment method. This study aimed to investigate the impact of RME on the soft tissues of the orofacial region in pediatric patients. The study included two groups: an experimental group comprising 30 patients (16 females and 14 males) with maxillary skeletal transverse deficiency who required rapid maxillary expansion (RME), and a control group consisting of patients (10 females and 10 males) who did not require RME or orthodontic treatment. Frontal and profile photographs were taken before and after RME for both groups. Frontal photographs were used to obtain 12 linear measurements, while profile photographs were used to perform 2 linear and 2 angular measurements using the “protractor” and “pixel ruler” software. Burstone-Legan, Steiner and Rickett’s analyses were performed to determine the locations of the upper and lower lips. Student t-test, paired samples t-test and Mann-Whitney U test were used to evaluate the data. In the experimental group, there was a statistically significant increase in nose width and intercommissural distance at the end of the treatment (p < 0.05). Similarly, both the experimental and control groups showed a statistically significant increase in the dorsum of nose length at T2 compared to the initial measurement (p < 0.05). Furthermore, the male participants in the experimental group exhibited a statistically significantly higher increase in nose length and dorsum of the nose during the T1 and T2 periods compared to the female participants in the experimental group (p < 0.05). RME may lead to changes in soft tissues in pediatric patients and was observed to be gender-specific. However, these changes were not clinically noticeable, and long-term follow-up studies are needed to determine the long-term effects of these changes.

Orthodontics; Maxillary expansion; Pediatrics; Soft tissue

[1] Masucci C, Franchi L, Franceschi D, Pierleoni F, Giuntini V. Post-pubertal effects of the Alt-RAMEC/FM and RME/FM protocols for the early treatment of Class III malocclusion: a retrospective controlled study. European Journal of Orthodontics. 2022; 44: 303–310.

[2] Büyükçavuş MH. Alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol: a comprehensive literature review. Turkish Journal of Orthodontics. 2019; 32 47–51.

[3] Chamberland S, Proffit WR. Short-term and long-term stability of surgically assisted rapid palatal expansion revisited. American Journal of Orthodontics and Dentofacial Orthopedics. 2011; 139: 815–822.e1.

[4] Iwasaki T, Papageorgiou SN, Yamasaki Y, Ali Darendeliler M, Papadopoulou AK. Nasal ventilation and rapid maxillary expansion (RME): a randomized trial. European Journal of Orthodontics. 2021; 43: 283–292.

[5] Lo Giudice A, Ronsivalle V, Lagravere M, Leonardi R, Martina S, Isola G. Transverse dentoalveolar response of mandibular arch after rapid maxillary expansion (RME) with tooth-borne and bone-borne appliances. The Angle Orthodontist. 2020; 90: 680–687.

[6] Bala AK, Campbell PM, Tadlock LP, Schneiderman ED, Buschang PH. Short-term skeletal and dentoalveolar effects of overexpansion. The Angle Orthodontist. 2022; 92: 55–63.

[7] Minervini G, Franco R, Marrapodi MM, Fiorillo L, Cervino G, Cicciù M. Economic inequalities and temporomandibular disorders: a systematic review with meta‐analysis. Journal of Oral Rehabilitation. 2023; 50: 715–723.

[8] Lagravere MO, Major PW, Flores-Mir C. Long-term dental arch changes after rapid maxillary expansion treatment: a systematic review. The Angle orthodontist. 2005; 75: 155–161.

[9] Lanteri V, Cossellu G, Gianolio A, Beretta M, Lanteri C, Cherchi C, et al. Comparison between RME, SME and leaf expander in growing patients: a retrospective postero-anterior cephalometric study. European Journal of Paediatric Dentistry. 2018; 19: 199–204.

[10] Minervini, G.; Franco, R.; Marrapodi, M.M.; Fiorillo, L.; Cervino, G.; Cicciù, M. Prevalence of temporomandibular disorders (TMD) in pregnancy: a systematic review with meta‐analysis. Journal of Oral Rehabilitation. 2023; 50: 627–634.

[11] dos Santos BM, Stuani AS, Stuani AS, Faria G, Quintao CC, Sasso Stuani MB. Soft tissue profile changes after rapid maxillary expansion with a bonded expander. The European Journal of Orthodontics. 2012; 34: 367–373.

[12] Kanomi R, Deguchi T, Kakuno E, Takano-Yamamoto T, Roberts WE. CBCT of skeletal changes following rapid maxillary expansion to increase arch-length with a development-dependent bonded or banded appliance. The Angle Orthodontist. 2013; 83: 851–857.

[13] Minervini G, Franco R, Marrapodi MM, Ronsivalle V, Shapira I, Cicciù M. Prevalence of temporomandibular disorders in subjects affected by Parkinson disease: a systematic review and metanalysis. Journal of Oral Rehabilitation. 2023: 50: 877–885.

[14] Akan B, Gökçe G, Şahan AO, Veli İ. Tooth-borne versus tooth-bone-borne rapid maxillary expanders according to a stereophotogrammetric evaluation of facial soft tissues: a randomized clinical trial. Orthodontics & Craniofacial Research. 2021; 24: 438–448.

[15] Chung C, Font B. Skeletal and dental changes in the sagittal, vertical, and transverse dimensions after rapid palatal expansion. American Journal of Orthodontics and Dentofacial Orthopedics. 2004; 126: 569–575.

[16] Torun GS. Soft tissue changes in the orofacial region after rapid maxillary expansion: a cone beam computed tomography study. Journal of Orofacial Orthopedics. 2017; 78: 193–200.

[17] Farfel V, Morea GC, Ferreira LM, Pereira MD. Evaluation of sagittal and vertical changes in maxillary dental, skeletal, and soft tissue following surgically assisted rapid maxillary expansion: a retrospective longitudinal study. The Journal of Craniofacial Surgery. 2022; 33: e398–e401.

[18] Lanteri V, Gianolio A, Gualandi G, Beretta M. Maxillary tridimensional changes after slow expansion with leaf expander in a sample of growing patients: a pilot study. European Journal of Paediatric Dentistry. 2018; 19: 29–34.

[19] Truong CT, Jeon HH, Sripinun P, Tierney A, Boucher NS. Short-term and long-term effects of rapid maxillary expansion on the nasal soft and hard tissue. The Angle Orthodontist. 2021; 91: 46–53.

[20] Aras I, Ölmez S, Akay MC, Günbay T, Aras A. The effects of maxillary expansion on the soft tissue facial profile. Journal of Istanbul University Faculty of Dentistry. 2017; 51: 1–10.

[21] Nada RM, van Loon B, Maal TJJ, Bergé SJ, Mostafa YA, Kuijpers-Jagtman AM, et al. Three-dimensional evaluation of soft tissue changes in the orofacial region after tooth-borne and bone-borne surgically assisted rapid maxillary expansion. Clinical Oral Investigations. 2013; 17: 2017–2024.

[22] Gao J, Wang X, Qin Z, Zhang H, Guo D, Xu Y, et al. Profiles of facial soft tissue changes during and after orthodontic treatment in female adults. BMC Oral Health. 2022; 22: 257.

[23] Nedeljkovic N, Cubrilo D, Hadzi-Mihailovic M. Changes in soft tissue profile following the treatment using a Herbst appliance: a photographic analysis. Vojnosanitetski Pregled. 2014; 71: 9–15.

[24] Jaiswal P, Gandhi A, Gupta AR, Malik N, Singh SK, Ramesh K. Reliability of photogrammetric landmarks to the conventional cephalogram for analyzing soft-tissue landmarks in orthodontics. Journal of Pharmacy and Bioallied Sciences. 2021; 13: S171–S175.

[25] Londoño A, Assis M, Fornai C, Greven M. Premolar extraction affects mandibular kinematics. European Journal of Dentistry. 2022. [Preprint].

[26] Mora-Zuluaga N, Soto-Llanos L, Aragón N, Torres-Trujillo K. Relationship of malocclusions with disorders of the temporomandibular joint in children of CALI—Colombia. European Journal of Dentistry. 2022; 16: 781–786.

[27] Soh J, Wang ZD, Zhang WB, Kau CH. Smile attractiveness evaluation of patients selected for a U.S.—based board certification examination. European Journal of Dentistry. 2021; 15: 630–638.

[28] Tiro A, Nakas E, Arslanagic A, Markovic N, Dzemidzic V. Perception of dentofacial aesthetics in school children and their parents. European Journal of Dentistry. 2021; 15: 13–19.

[29] Gül A, de Jong MA, de Gijt JP, Wolvius EB, Kayser M, Böhringer S, et al. Three-dimensional soft tissue effects of mandibular midline distraction and surgically assisted rapid maxillary expansion: an automatic stereophotogrammetry landmarking analysis. International Journal of Oral and Maxillofacial Surgery. 2019; 48: 629–634.

[30] Öztürk SA, Malkoç S, Yolcu Ü, İleri Z, Güler ÖÇ. Three-dimensional soft tissue evaluation after rapid maxillary expansion and mandibular midline distraction osteogenesis. The Angle Orthodontist. 2021; 91: 634–640.

[31] Nguyen H, Shin JW, Giap H, Kim KB, Chae HS, Kim YH, et al. Midfacial soft tissue changes after maxillary expansion using micro-implant-supported maxillary skeletal expanders in young adults: a retrospective study. Korean Journal of Orthodontics. 2021; 51: 145–156.

[32] Spagnuolo G. Cone-beam computed tomography and the related scientific evidence. Applied Sciences. 2022; 12: 7140.

[33] Kochhar AS, Sidhu MS, Prabhakar M, Bhasin R, Kochhar GK, Dadlani H, et al. Intra- and interobserver reliability of bone volume estimation using OsiriX software in patients with cleft lip and palate using cone beam computed tomography. Dentistry Journal. 2021; 9: 14.

[34] Dindar M, Açıkgöz-Alparslan E, Tekbaş-Atay M. Radiographic evaluation of marginal bone height and density around overhanging dental restorations. The International Journal of Periodontics & Restorative Dentistry. 2022; 42: 401–408.

[35] Büyükgöze Dindar M, Tekbaş Atay M. The effect of toothbrush abrasion on wear and surface roughness of direct and indirect composite laminate veneer restorations. Surface Topography: Metrology and Properties. 2020; 8: 035007.

[36] Lo AL, Hallac RR, Chen SH, Hsu KH, Wang SW, Chen CH, et al. Craniofacial growth and asymmetry in newborns: a longitudinal 3D assessment. International Journal of Environmental Research and Public Health. 2022; 19: 12133.

[37] Erten O, Yilmaz BN. Three-dimensional imaging in orthodontics. Turkish Journal of Orthodontics. 2018; 31: 86–94.

[38] Marcu M, Hedesiu M, Salmon B, Pauwels R, Stratis A, Oenning ACC, et al. Estimation of the radiation dose for pediatric CBCT indications: a prospective study on ProMax3D. International Journal of Paediatric Dentistry. 2018; 28: 300–309.

[39] Minervini G, Franco R, Marrapodi MM, Crimi S, Badnjević A, Cervino G, et al. Correlation between temporomandibular disorders (TMD) and posture evaluated trough the diagnostic criteria for temporomandibular disorders (DC/TMD): a systematic review with meta-analysis. Journal of Clinical Medicine. 2023; 12: 2652.

[40] Shetty A, Ratti S, Nakra P, Shetty S, Mohammed A, Saidath K. Evaluation of soft tissue and airway changes in individuals treated with mini-implant assisted rapid palatal expansion (MARPE). Journal of Long-Term Effects of Medical Implants. 2022; 32: 7–18.

[41] Qamar Z, Alghamdi AMS, Haydarah NKB, Balateef AA, Alamoudi AA, Abumismar MA, et al. Impact of temporomandibular disorders on oral health‐related quality of life: a systematic review and meta‐analysis. Journal of Oral Rehabilitation. 2023; 50: 706–714.

[42] Akbulut S, Yilmaz S, Yagci A. Comparison of the short-term effects of facemask therapy preceded by conventional rapid maxillary expansion or by an alternate rapid maxillary expansions and constrictions protocol: a retrospective study. Journal of Orofacial Orthopedics. 2022. [Preprint].

[43] Mangone E, Cataneo E, Fortunato L, Cresti L. Functional removable prosthetic rehabilitation using the electronic condylograph: a case report. Prosthesis. 2021; 3: 437–445.

[44] D’Addazio G, Xhajanka E, Cerone P, Santilli M, Rexhepi I, Caputi S, et al. Traditional removable partial dentures versus implant-supported removable partial dentures: a retrospective, observational oral health-related quality-of-life study. Prosthesis. 2021; 3: 361–369.

[45] Arnould A, Hendricusdottir R, Bergmann J. The complexity of medical device regulations has increased, as assessed through data-driven techniques. Prosthesis. 2021; 3: 314–330.

[46] Pugliese A, Cataneo E, Fortunato L. Construction of a removable partial denture (RPD): comparison between the analog procedure and the selective laser melting procedure. Prosthesis. 2021; 3: 428–436.

[47] Ahmed N, Humayun M, Abbasi M, Jamayet N, Habib S, Zafar M. Comparison of canine-guided occlusion with other occlusal schemes in removable complete dentures: a systematic review. Prosthesis. 2021; 3: 85–98.

[48] Kokich VO, Asuman Kiyak H, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. Journal of Esthetic and Restorative Dentistry. 1999; 11: 311–324.

[49] Silva B, Jimenez-Castellanos E, Martinez-de-Fuentes R, Greenberg J, Chu S. Laypersons’ perception of facial and dental asymmetries. The International Journal of Periodontics & Restorative Dentistry. 2013; 33: e162–e171.

[50] Naini FB, Donaldson ANA, McDonald F, Cobourne MT. Assessing the influence of chin prominence on perceived attractiveness in the orthognathic patient, clinician and layperson. International Journal of Oral and Maxillofacial Surgery. 2012; 41: 839–846.