Procedure using CAD/CAM-manufactured insertion guides for purely mini-implant-borne rapid maxillary expanders.

Benedict Wilmes,Renzo De Gabriele,Dieter Drescher,Nour Eldin Tarraf,Gianluca Dallatana

doi:10.1007/s00056-022-00375-w

Abstract

With traditional rapid palatal expansion (RPE), orthopaedic forces are transmitted to the skeletal structures via the anchor teeth potentially leading to several unwanted dental side effects. To prevent these issues, tooth–bone-borne or purely bone-borne expanders were introduced using mini-implants in the palate. In this paper, the digitally planned Quadexpander is described which permits palatal expansion with only skeletal anchorage. The use of virtual insertion planning allows for insertion in areas of ideal bone, while avoiding roots and vital structures as well as the possibility of insertion into sites which would otherwise not be considered usable. A second advantage of digital planning is that mini-implants and the expander can be inserted in just one appointment.

Highlights

Rapid palatal expansion (RPE) was first described by Angell [1] in 1860 and has been widely used to skeletally expand the maxilla
The orthopaedic forces are transmitted to the skeletal structures via the anchor teeth, which may lead to several unwanted dental side effects such as buccal tipping, fenestration of the buccal bone, root resorption, and gingival recessions even in children [2, 5, 7, 25]
Mini-implants have a high success rate in the anterior palate when inserted in the so-called T-zone [12, 17, 32], the area of the bicuspids median or paramedian

Summary

Introduction

Rapid palatal expansion (RPE) was first described by Angell [1] in 1860 and has been widely used to skeletally expand the maxilla. Mini-implants have a high success rate in the anterior palate when inserted in the so-called T-zone [12, 17, 32], the area of the bicuspids median or paramedian This area provides good bone quality and minimal risk of injury to nerves, vessels or roots. The Quadexpander is manufactured on this model using a preformed screw (Power Expander, Tiger Dental, Bregenz, Austria) welded to four preformed rings (PSM, Gunningen, Germany) which are positioned on the laboratory TAD analogues and connected to the expansion screw while bending the arms and adapting it to the shape of the palate. After 32 days, a sufficient expansion was achieved (Fig. 8)

Discussion

Conclusion