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Analysis of skeletal and dental changes with a tooth-borne and a bone-borne maxillary expansion appliance assessed through digital volumetric imaging Open Access


Other title
three-dimensional analysis
cone-beam computerized tomography
bone-borne maxillary expander
rapid maxillary expansion
Type of item
Degree grantor
University of Alberta
Author or creator
Lagravere Vich, Manuel Oscar
Supervisor and department
Jason Carey (Mechanical Engineering)
Paul W. Major (Dentistry)
Examining committee member and department
Robert Lambert (Radiology and Diagnostic Imaging)
Arthur J. Miller (Orofacial Sciences, Physiology)
Paul W. Major (Dentistry)
Jason Carey (Mechanical Engineering)
Giseon Heo (Dentistry)
Marc Secanell Gallart (Mechanical Engineering)
Roger Toogood (Mechanical Engineering)
Department of Dentistry

Date accepted
Graduation date
Degree level
The purpose of this research was to compare skeletal and dental changes assessed by digital volumetric images produced during and after rapid maxillary expansion (RME) between a bone-borne anchored expansion appliance and a conventional tooth-borne RME. Initial steps included the development of a methodology to analyze CBCT images. Reliability of traditional two dimensional (2D) cephalometric landmarks identified in CBCT images was explored, and new landmarks identifiable on the CBCT images were also evaluated. This methodology was later tested through a clinical trial with 62 patients where skeletal and dental changes found after maxillary expansion using either a bone-borne or tooth-borne maxillary expander and compared to a non-treated control group. The conclusions that were obtained from this thesis were that the NewTom 9” and 12” three dimensional (3D) images present a 1-to-1 ratio with real coordinates, linear and angular distances obtained by a coordinate measurement machine (CMM). Landmark intra- and inter-reliability (ICC) was high for all CBCT landmarks and for most of the 2D lateral cephalometric landmarks. Foramen Spinosum, foramen Ovale, foramen Rotundum and the Hypoglossal canal all provided excellent intra-observer reliability and accuracy. Midpoint between both foramen Spinosums (ELSA) presented a high intra-reliability and is an adequate landmark to be used as a reference point in 3D cephalometric analysis. ELSA, both AEM and DFM points presented a high intra-reliability when located on 3D images. Minor variations in location of these landmarks produced unacceptable uncertainty in coordinate system alignment. The potential error associated with location of distant landmarks is unacceptable for analysis of growth and treatment changes. Thus, an alternative is the use of vectors. Selection of landmarks for use in 3D image analysis should follow certain characteristics and modifications in their definitions should be applied. When measuring 3D maxillary complex structural changes during maxillary expansion treatments using CBCT, both tooth-anchored and bone-anchored expanders presented similar results. The greatest changes occurred in the transverse dimension while changes in the vertical and antero-posterior dimension were negligible. Dental expansion was also greater than skeletal expansion. Bone-anchored maxillary expanders can be considered as an alternative choice for tooth-anchored maxillary expanders.
License granted by Manuel Lagravere Vich ( on 2009-08-06T15:39:03Z (GMT): Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of the above terms. The author reserves all other publication and other rights in association with the copyright in the thesis, and except as herein provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
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