Use of miniscrew-assisted rapid palatal expansion before bimaxillary orthognathic surgery: A case report

Abstract

Class III malocclusions have been one of the major challenge to correct skeletal and dentofacial anomalies in orthodontics, some class III patients have a maxillary hypoplasia resulting in an transverse discrepancy, the golden standard for treat patients with severe class III skeletal malocclusions consists in a orthodontic therapy and orthognathic surgery, currently Mini-screw assisted rapid palatal expansion with (MARPE) is an efficient procedure for correcting maxillary transverse deficiency even in adult patients. A 25-year class III skeletal female patient with hyperdivergent growth anterior and posterior crossbite and laterognathia was treated, presurgical miniscrew assisted rapid palatal expansion was chosen to correct the patient's transverse deficiency, bimaxillary surgery was conducted to treat the mandibular hyperplasia and facial asymmetry. Surgery consisted in 1-piece Lefort to correct maxillary canting and BSSO to correct laterognathia. The treatment was complete in 18 months, CBCT images reveal the maxillary expansión, all dental and skeletal goals were achieved and the facial result was evidente. MARPE can be use before bimaxillary orthognathic surgery to correct transverse maxillary discrepancy and posterior cross-bite in adult patients, however different factors such as the severity of the deficiency, age, and the conditions of the perimaxillary sutures must be taken.