Safety and Effects of the Rapid Maxillary Expander on Temporomandibular Joint in Subjects Affected by Juvenile Idiopathic Arthritis: A Retrospective Study

Abstract

Background: In Juvenile Idiopathic Arthritis (JIA) temporo-mandibular joints are often affected causing skeletal and dental malocclusions. The most frequent condition is mandibular hypoplasia, that may be associated with maxillary hypoplasia. The aim of this retrospective case control study is to investigate the effects and the safety of rapid maxillary expansion (RME) in growing patients affected by JIA. It was evaluated whether RME could be performed without complications on TMJs of JIA patients using DC/TMD protocol, and naso-maxillary transversal parameters were compared with the ones obtained on healthy patients. Methods: Twenty-five patients affected by JIA that ceased to manifest TMJ (Temporo-Mandibular Joint) symptoms in the previous year were treated with RME to solve the maxillary transverse hypoplasia. Postero-anterior cephalometric tracings were collected before and after treatment; linear measurements were obtained to study maxillary and nasal cavity modifications. Data were compared to those of a similar group of twenty-five healthy patients. Paired t-test and Independent t-test were used to evaluate changes before and after treatment in each group and to perform a comparison between the groups. Results: All patients demonstrated a statistically significant increase in nasal cavity width, maxillary width and upper and lower intermolar width. No patients presented a worsening of their TMJs condition. Intragroup comparisons revealed significant changes of cephalometric measurements, but no difference was found when comparing JIA and healthy patients. Conclusions: Growing patients with JIA that ceased to show signs of active TMJ involvement for at least one year could be safely treated with RME, expecting similar benefits to those of healthy patients. Dentists and rheumatologists should be informed of safety and potential benefits of palatal expansion in JIA patients in order to improve the outcome of orthodontic treatment and reduce the indication for more invasive procedures (i.e., Surgical Assisted Rapid Maxillary Expansion).

Analysis of Earlier Temporomandibular Joint Disorders in JIA Patients: A Clinical Report

“…Despite these clinical alterations, recent studies have shown that JIA patients that ceased to show signs of active TMJ involvement for at least one year may find benefits from rapid maxillary expansion treatment, since resolving maxillary hypoplasia and impaired dental contacts may allow mandibular repositioning and condylar growth [ 15 , 16 ].…”

Cephalometric Changes Following Maxillary Expansion with Ni-Ti Leaf Springs Palatal Expander and Rapid Maxillary Expander: A Retrospective Study

“…Orthopedic maxillary expansion can be achieved using different fixed appliances that use deciduous or permanent teeth or miniscrews for support to transmit a lateral force to the two palatal processes of the maxillary bone, producing the splitting of the midpalatal suture and a certain amount of widening of the maxillary sutures [1]. The force is generated by a transversal screw that delivers a variable amount of force depending on several factors such as the activation protocol, its relative position in the palatal vault and its type of support.…”

Three-dimensional volumetric evaluation of the different mandibular segments using CBCT in patients affected by juvenile idiopathic arthritis: a cross-sectional study

“…The condylar surface damage is frequently clinically silent, i.e., it evolves without subjective or clinical expressions, which often causes a delay in diagnosis, Moreover, reliable monitoring during therapy is often hampered by the absence of pain and palpable swelling [14,15]. Symptoms, such as decreased mouth opening capacity (deviation of the mandible on mouth opening) and joint noises (crepitation and/or clicking), are not only usually noted late, but are also often underestimated [16].…”