Magnetic versus mechanical expansion with different force thresholds and points of force application

Abstract

The effects of force magnitude (high versus low) and point of force application (teeth versus direct palatal endosseous pins) on palatal expansion treatment were studied on four juvenile female Macaca fascicularis monkeys. Three subjects received one of the following appliances: (1) conventional type jackscrew maxillary plate bonded to the posterior teeth with a high force magnitude of 2033 g, (2) a similar tooth-borne appliance but with rare earth repulsive magnets having a low force of 258 g, or (3) a specially designed palatal acrylic appliance pinned directly to the palatal shelves also utilizing rare earth repulsive magnets with a low force of 258 g. A fourth animal, the control, received a passive sham appliance bonded to the abutment teeth. Spatial changes of dental markers and facial implants were studied radiographically. In the low force, magnetically induced appliances, treatment was longer (95 days for the palatally pinned appliance and 135 days for the bonded tooth-borne appliance). The force radiated superolatelly, dissipating in the zygomaticofrontal suture, and the overjet significantly increased because of the marked widening of the incisive and transverse sutures. With the conventional jackscrew high-force appliance bonded to the teeth, the treatment lasted 33 days. A diastema developed between the incisors and the force was transmitted superolaterally and then transmedially, thus causing fractures in the nasal complex and other iatrogenic sequelae. The palatally pinned magnetic appliance induced bodily tooth movement, the greatest increase in intermolar distance, and a superior repositioning of the maxillopalatine region. The latter two effects were caused by selective excitation of the transverse suture over the premaxillary suture. Symmetry decreased with remoteness from the point of application. These results suggest reduction of the conventional force by up to eightfold—a level supplied by the rare earth magnets. Extrapolating from these results, the slow palatal expansion regimen for the treatment of Class III malocclusions with maxillary transverse deficiency is preferred at an early age (not more than 6 years). In the event of a suture disorder, the use of direct forces to the palate might be considered.