Extensiometric analysis of strain in craniofacial bones during implant-supported palatal expansion.

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Palatal expansion has several orthodontic and orthopedic applications, such as increasing maxillary transverse dimensions and correcting maxillary atresia, oral breathing, and skeletal cross-bites. Little is known about the strain to which craniofacial bones are submitted when a palatal expander is loaded. The objectives of the present work were to propose a new palatal bone-borne titanium device (expansion screw), to determine patterns of strain distribution in craniofacial bones during palatal expansion and to show the clinical results of a new palatal expander supported by implants. For in vitro testing, the palatal expander supported by two commercially pure titanium (cp Ti) implants was inserted parallel to the median palatine suture of four dry adult human skulls. Uniaxial and triaxial strain gauges were attached to craniofacial bones and connected to a signal acquisition system. An expansion screw was turned and strain data were collected during palatal expansion. The results showed that the bone strain distribution in craniofacial bones loaded by the palatal bone-borne titanium device was complex: the strain was tensile in the palatine cortical bone and compressive in pterygopalatine processes, nasal bones, and orbital floor. The maximum compressive strain occurs in the upper portion of the pterygopalatine processes and the strain changes from compressive to tensile in the zygomatic process. The experimental results suggest that the bone strain due to the palatal expander is distributed over all craniofacial bones and that the upper portions of pterygopalatine processes are the main sites of resistance to palatal expansion. The new palatal expander supported by two cp Ti implants proposed was employed on adult patient as an illustrative report, where adequate palatal expansion was achieved. The new protocol proposed was less invasive, risky, painful and costless for the correction of moderate maxillary transverse deficiency.