Reducing relapse and accelerating osteogenesis in rapid maxillary expansion using an injectable mesoporous bioactive glass/fibrin glue composite hydrogel

Rapid maxillary expansion(RME),as a common treatment for craniomaxillofacial deformity,faces the challenge of high relapse rates and unsatisfactory therapeutic effects.In this study,a standardized Sprague-Dawley(SD)rat RME model was first established with a modified expander as well as retainer design and optimized anterior maxillary expanding force of 100 g which exerted the most synchronized mobility of mid-palatal suture and incisors.Via the standardized model,the high relapse rate was proven to be attributed to insufficient osteogenesis in expanded suture,requiring long-term retainer wearing in clinical situations.To reduce the relapse rate,mesoporous bioactive glass/fibrin glue(MBG/FG)composite hydrogels were developed for an in situ minimal invasive injection that enhance osteogenesis in the expanded palate.The component of 1 wt%MBG was adopted for enhanced mechanical strength,matched degradation rate and ion dissolution,excellent in vitro biocompatibility and osteoinductivity.Effects of 1%MBG/FG composite hydrogel on osteogenesis in expanded mid-palatal sutures with/without retention were evaluated in the standardized model.The results demonstrated that injection of 1%MBG/FG composite hydrogel significantly promoted bone formation within the expanded mid-palatal suture,inhibited osteoclastogenesis and benefited the balance of bone remodeling towards osteogenesis.Combination of retainer and injectable biomaterial was demonstrated as a promising treatment to reduce relapse rate and enhance osteogenesis after RME.The model establishment and the composite hydrogel development in this article might provide new insight to other craniomaxillofacial deformity treatment and design of bone-repairing biomaterials with higher regenerative efficiency.

Evaluating the effect of midpalatal corticotomy-assisted rapid maxillary expansion on the upper airway in young adults using computational fluid dynamics

Midpalatal corticotomy-assisted rapid maxillary expansion(MCRME)is a minimally invasive treatment of maxillary transverse deficiency(MTD)in young adults.However,the effect of MCRME on respiratory function still needs to be determined.In this study,we evaluated the changes in maxillary morphology and the upper airway following MCRME using computational fluid dynamics(CFD).Twenty patients with MTD(8 males,12 females;mean age 20.55 years)had cone-beam computed tomography(CBCT)images taken before and after MCRME.The CBCT data were used to construct a threedimensional(3 D)upper airway model.The upper airway flow characteristics were simulated using CFD,and measurements were made based on the CBCT images and CFD.The results showed that the widths of the palatal bone and nasal cavity,and the intermolar width were increased significantly after MCRME.The volume of the nasal cavity and nasopharynx increased significantly,while there were no obvious changes in the volumes of the oropharynx and hypopharynx.CFD simulation of the upper airway showed that the pressure drop and maximum velocity of the upper airway decreased significantly after treatment.Our results suggest that in these young adults with MTD,increasing the maxillary width,upper airway volume,and quantity of airflow by MCRME substantially improved upper airway ventilation.

Alternatives to surgery in children with mild OSA

Precision medicine requires coordinated and integrated evidence-based combinatorial approaches so that diagnosis and treatment can be tailored to the individual patient.In this context,the treatment approach to mild obstructive sleep apnea(OSA)is fraught with substantial debate as to what is mild OSA,and as to what constitutes appropriate treatment.As such,it is necessary to first establish a proposed consensus of what criteria need to be employed to reach the diagnosis of mild OSA,and then examine the circumstances under which treatment is indicated,and if so,whether and when anti-inflammatory therapy(AIT),rapid maxillary expansion(RME),and/or myofunctional therapy(MFT)may be indicated.