Abstract
The introduction of miniscrew-assisted rapid palatal expansion (MARPE) has widened the boundaries of orthodontic skeletal correction of maxillary transversal deficiency to late adolescence and adult patients. In this respect, Maxillary Skeletal Expander (MSE) is a particular device characterized by the engagement of four miniscrews in the palatal and nasal cortical bone layers. Thus, the availability of sufficient supporting bone and the perforation of both cortical laminas (bi-corticalism) are two mandatory parameters for mini-screw stability, especially when orthopedic forces are used. Virtual planning and construction of MSE based on cone-beam computed tomography (CBCT)-derived stereolithography (.stl) files have been recently described in the literature. In this manuscript we described: (a) a user-friendly digital workflow which can provide a predictable placement of maxillary skeletal expander (MSE) appliance according to the patient’s anatomical characteristics, (b) the construction of a positional template of the MSE that allows lab technician to construct the MSE appliance in a reliable and accurate position, according to the virtual project planned by the orthodontist on the patient CBCT scans. We also described a case report of an adult female patient affected by skeletal transversal maxillary deficiency treated with MSE appliance that was projected according to the described workflow.
Highlights
Rapid maxillary expansion (RME) represents the standard treatment for the correction of a skeletal transversal maxillary deficiency in growing subjects [1,2,3,4,5]
Appliance according to the patient’s anatomical characteristics, (b) the construction of a positional template of the maxillary skeletal expander (MSE) that allows lab technician to construct the MSE appliance in a reliable and accurate position, according to the virtual project planned by the orthodontist on the patient cone-beam computed tomography (CBCT) scans
We described a case report of an adult female patient affected by skeletal transversal maxillary deficiency treated with MSE appliance that was projected according to the described workflow
Summary
Rapid maxillary expansion (RME) represents the standard treatment for the correction of a skeletal transversal maxillary deficiency in growing subjects [1,2,3,4,5]. A pure skeletal opening is not attainable, while unfavorable effects were found in the anchoring teeth and supporting tissue such as root resorption, marginal bone loss, and reduction of buccal bone thickness [6,7,8,9] The risk of these side effects increases in adult subjects due to the greater compensatory movement of dento-alveolar complex caused by the difficulty in opening the midpalatal suture [1]. In this respect, miniscrew-assisted rapid palatal expansion (MARPE) has been proposed as an effective method to obtain the skeletal opening of the midpalatal suture in late adolescents and Materials 2020, 13, 1815; doi:10.3390/ma13081815 www.mdpi.com/journal/materials [10]. The dental anchorage can be completely avoided (bone-born expander), or the anchorage system can partially rest on dentition of 12
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