Bone-borne Distractor Research Articles

Anterior Maxillary Distraction Osteogenesis With Bone-borne Intraoral Buccal Devices for Maxillary Hypoplasia With Cleft Lip and Palate.

Anterior maxillary distraction osteogenesis (AMDO) surgery for cleft lip and palate involves distraction of a segment of the anterior maxilla and advancement using 2 intraoral buccal bone-borne distraction devices. The anterior part of the maxilla is advanced anteriorly with less relapse which increases maxillary length and does not affect speech. We aimed to evaluate the effects of AMDO, including lateral cephalometric changes. Seventeen patients who had undergone this procedure were included in this retrospective study. The distractors were activated by 0.5mm twice a day after a 3-day latency period. Lateral cephalometric radiographs were evaluated preoperatively, after distraction and removal of distractors, which were compared using the paired Student's t test. Anterior maxillary advancement was obtained in all patients with a median of 8.0mm. Complications included nasal bleeding and loosening of distractors; however, there was no tooth damage or abnormal movement. The mean sella-nasion-A point (SNA) angle increased significantly, from 74.91° to 79.66°, the A point-nasion-B point angle from -0.38° to 4.34°, and the perpendicular line from nasion to Frankfort Horizontal (NV)-A point from -5.11 to 0.08mm. The mean anterior nasal spine-posterior nasal spine length increased significantly from 50.74 to 55.10mm, and the NV-Nose Tip from 23.59 to 26.27mm. The mean relapse rate of NV-A was 11.1%. AMDO with bone-borne distractor resulted in less relapse and effectively corrected the maxillary retrusion.

Outcomes of Bifocal Transport Distraction Osteogenesis for Repairing Complicated Unilateral Alveolar Cleft

This study aimed to assess the outcomes of bifocal transport distraction osteogenesis (BTDO) for closure of a wide or previously failed unilateral alveolar cleft. Patient in this study had a large alveolar cleft that had not healed with bone grafts. Bone-borne distraction was used under general anesthesia. Intraoperative complications as bleeding and trauma to neighboring teeth were documented. Postoperative complications as wound dehiscence, paresthesia, infection, and bleeding were recorded. Complications including changes in bone segment movement, activation force loss, and occlusal interferences were observed during the activation phase. During the consolidation phase, problems including gingival recession, pulpal vitality, and cosmetic concerns were evaluated. Postoperative, periapical, occlusal, and orthopantomograms were used to evaluate bone gain and bone generation in the distracted area. Ten patients (6 males and 4 females) with unilateral alveolar cleft were included, with mean age of 9.5 ± 2.5 years. Average cleft width was 12.25 ± 2.54 mm. There was no intraoperative or postoperative bleeding. Only 1 patient had a wound dehiscence (10%). All patients had mild postoperative pain and edema in upper lip. Only 1 patient complained of numbness in infraorbital nerve's innervated region. Radiographs revealed bone formation in cleft area and bone healing in distracted chamber. Bifocal transport distraction osteogenesis improves success rate of an alveolar cleft treatment especially a wide or previously failed one. This technique associated with minimal complications when careful planning and cooperation from a patient are combined. It can be recommended when other modalities for alveolar cleft are failed. Patients also tolerate the device well.

Patient experience and satisfaction of surgically assisted rapid maxillary expansion and mandibular midline distraction

Little is known regarding patient experience and satisfaction with surgically assisted rapid maxillary expansion (SARME) and mandibular midline distraction (MMD). This study therefore aimed to assess patient experience and satisfaction with these techniques in two different groups. The first group answered the post-surgical patient satisfaction questionnaire on a 7-point Likert scale during a long-term follow-up recall. The second group answered a visual analogue scale questionnaire (range: 0–10) with different questions regarding experience and satisfaction, at different time points during the first year of treatment. In both groups, 17 patients were included. Regarding the post-surgical patient satisfaction questionnaire, a mean satisfaction rate of 6.4 (range: 4–7) was reported, with a mean follow-up of 6.5 years post-operatively. In the visual analogue scale group, the mean satisfaction rate was 8.0 and did not significantly differ from the expectations pre-operative (P = 0.96). Both procedures showed relatively low pain scores, although a significant higher score was observed in MMD post-operatively (P = 0.00051). Regarding hindrance, the scores were moderate; the bone-borne distractor in the mandible gained higher scores than the tooth-borne distractor in the mandible. In conclusion, both SARME and MMD gain high satisfaction rates.

Bone-borne distractor versus tooth-borne distractor for maxillary expansion: a Systematic Review

The etiology of transverse maxillary deficiency is considered multifactorial, and has a deleterious effect on the bone development of the maxilla and nasal cavities, causing maxillary atresia and posterior crossbite. The objective of this systematic review was to compare in the scientific literature the effectiveness of the maxillary disjunction treated using dental distractor versus bone distractor. A systematic literature review was performed using the Science Direct, Embase, Cochrane Collaboration Library, and PubMed / MEDLINE databases. The search strategy provided a total of 119 studies. After screening by reading the titles and abstracts, seven articles met all the criteria and were included in this systematic review. Studies have shown that the choice of type of orthodontic-orthopedic appliance is directly related to the prior individualized planning of each patient. With regard to patients who are in the development phase, the recommendation is the use of dental maxillary expanders, such as the Hyrax appliance. In addition, it is not recommended to perform rapid maxillary expansion in adult patients, due to the expansion resistance that occurs in the palatine sutures. The treatment of patients with closed median palatine suture must be done by surgically assisted maxillary expansion.

Immediate dental and skeletal influence of distractor position on surgically assisted rapid palatal expansion with or without pterygomaxillary disjunction

The outcome of surgically assisted rapid palatal expansion (SARPE) can be affected by pterygomaxillary disjunction (PMD) and the distractor position. In this study, SARPE was performed, with or without PMD, in 20 fresh cadaver heads. Transverse expansion was conducted twice using a bone-borne distractor in the anterior and posterior positions, resulting in four groups (n=10). Cone beam computed tomography scans were completed before and after SARPE to evaluate maxillary changes. A comparative anterior decrease and posterior increase in midpalatal opening resulted from SARPE with PMD combined with a posteriorly placed distractor. Significant differences in the internal transverse changes were found between the two SARPE techniques combined with an anterior distractor at the level of the premolars and molars for alveolar ridge width (P=0.040, P=0.024), and at the level of the molars for the dental crown width (P=0.017) and corresponding tooth cusp width (P=0.018). In contrast, using a posteriorly placed distractor led to a significant difference for tooth cusp width only (P=0.050). No statistically significant differences were found between external transverse changes or between distractor positions. PMD is more important in achieving a more uniform and parallel transverse expansion pattern than the distractor position. However, a posterior distractor seems to intensify the effects of PMD.

Displacement and stress distribution of the maxilla under different surgical conditions in three typical models with bone-borne distraction: athree-dimensional finite element analysis.

The present study compared the skeletal effects of surgically assisted rapid maxillary expansion (SARME) with different surgeries in three representative finite element (FE) models. According to the ossification level of midpalatal suture, three FE models, with different elasticity moduli of sutures (E = 1 MPa, 500 MPa, and 13,700 MPa) were constructed, to represent three age groups of patients. Within each model, four groups were set up according to different surgeries: groupI (control group without surgery), II (paramedian osteotomy), III (pterygomaxillary separation), and IV (paramedian osteotomy and pterygomaxillary separation). An expansion force of 100 N and 1mm displacement were applied via abone-borne distraction to simulate the expansion process. By analyzing these models, the maximum displacement of maxilla was observed in groupIV, with E = 1 MPa model exhibiting the most displacement (28.5 × 10-6 mm), followed by groupII (21.4 × 10-6 mm). GroupIV showed aunique backward-downward rotation with minimum stress distributions in three models (9 MPa, 131 MPa, and 140 MPa, respectively), and groupII exhibited comparable low stress distributions (12 MPa, 151 MPa, and 230 MPa, respectively). Lowest stress was found in E = 1 MPa model, compared with the other two models. There is no need to perform surgeries when the midpalatal suture is open, and surgery guidelines are the same for partial and complete fusion sutures. Furthermore, exclusive use of partial paramedian osteotomy is sufficient enough to reduce stress and expand the posterior part of maxilla, and it is less invasive.

Pharyngeal airway changes following symohyseal distraction osteogenesis

Introduction: The aim of this study was to analyze the effects of mandibular symphyseal distraction osteogenesis (MSDO) on the pharyngeal airway dimensions in a group of adult patients.Subjects and Methods: The sample consisted of digital lateral cephalograms of 10 patients (7 females and 3 males)with a mean age of 21.0 ± 2.5 years. Radiographs were taken before start of distraction (T1) and following distraction(T2) (12.5 days ± 2.3 days after surgery). Symphyseal distraction was done using a bone-borne distractor. The mean value of mandibular symphyseal distraction was 8.4 ± 1.7 mm. Digital lateral cephalometric tracing was done to evaluate airway changes following symphyseal distraction.Results: Digital lateral cephalometric analysis revealed no statistically significant changes in nasopharyngeal airway(0.3 ± 0.1 mm) (P > 0.05). There were statistically significant changes in oropharyngeal and hypopharyngeal airway widths (1.2 ± 0.3 mm) and (0.7 ± 0.4 mm) respectively (P 0.05) while statistically significant decrease were evident for the vertical measurement H-C3RGN (- 1.2 ± 0.2 mm) (P < 0.01).Conclusion: The results propose that MSDO significantly affects the lower pharyngeal airway dimensions but has no effect on the upper pharyngeal airway measurements. No significant effects on hyoid bone position were observed except mild decrease of its vertical measurement to reference planes. The normal reflex mechanisms that conserve the patency of the airway may have negated any potential changes in the hyoid bone position.

Front-block technical note: dental and bone borne distractors

Orthognathic surgical technique of segmental osteogenesis distraction of the anterior mandible alveolar process (front-block) was introduced by Triaca and al. in 2001 [2] including lower incisors. The technical note describes distraction process used both, dental-borne distractor and bone-borne distractor. A genioplasty plate was used as a bone-borne distractor. The main point here is that distraction depends on two distraction vectors, a dental one and an alveolar one. It provides good stability and controlled segmental osteogenesis translation and allows sufficient alveolar segmental transport without loading the teeth too heavily.

Bone-borne surgically assisted rapid maxillary expansion: A retrospective three-dimensional evaluation of the asymmetry in expansion

PurposeAsymmetrical expansion occurs in patients treated with Surgically Assisted Rapid Maxillary Expansion (SARME). In the clinical setting, this asymmetrical expansion is seen in multiple directions. However, the frequency, actual directions and amount of asymmetry are unclear. Hence, the aim of this study was to analyze the directions and amount of asymmetrical lateral expansion in non-syndromic patients with transversal maxillary hypoplasia on employing bone-borne transpalatal distraction by means of SARME. Treatment involved corticotomies of all four bony supports, including pterygomaxillary disjunction. Materials and methodsA retrospective case series was formed from patients treated with SARME. Pre- and postdistraction Cone Beam Computed Tomography scans were superimposed. A reference frame was created to analyze lateral expansion asymmetries in five directions. ResultsClinical relevant asymmetries (>3.0 mm) in at least one of the investigated directions occurred in 55% of the patients. Lateral expansion asymmetries occurred mostly in the inferior-anterior part between the left and right segment and asymmetry in total expansion was noted between the anterior and posterior part of the maxilla. ConclusionThis study confirms the clinical suspicion that using SARME with a bone-borne distractor and pterygomaxillary disjunction to treat non-syndromic patients with transversal maxillary hypoplasia, results in regular asymmetrical lateral expansion.

Development of a new three-directional distractor system for the correction of maxillary transverse and sagittal deficiency

PurposeClass 3 malocclusions with maxillary deficiency, which are treated surgically and/or ordonotically, are common among adult patients. The aim of this study was to develop a three-directional bone-borne distractor that would allow the transverse expansion and sagittal advancement of the maxilla simultaneously. Materials and methodsComputed tomography images of a patient with maxillary deficiency were transmitted to a software program, and a distractor was designed with different sizes (D1, D2, D3) and manufactured from titanium alloy. Y-shape segmental osteotomies were performed on the model, and vertical bite forces were applied. The biomechanical properties were evaluated by using the finite element method. ResultsThe highest von Mises stress value on the body of the distractor was seen in D2 (D2>D3>D1), with 234 N bite forces. D2 had maximum stress distribution on maxillary bone under 234 N and 93 N (D2>D1>D3). No difference was found among the plastic deformation rates according to biomechanical test results. ConclusionA three-directional bone-borne palatal distractor was produced, and this distractor system can be used for the treatment of skeletal class 3 patients with maxillary hypoplasia for its advantages of shortening the overall treatment time and reducing the scar formation. However, further animal and clinical studies are essential to determine the biological response of soft and hard tissues.

Comparison of symmetry of rapid maxillary expansion using a tooth-borne or a bone-borne distractor

Background: There are differences in the distraction pattern of tooth-borne versus bone-borne rapid maxillary expansion. However, patients suffer especially from visible asymmetric distraction of the two maxillary segments. These have not yet been described. Objectives: We investigate the asymmetry in distraction of the two maxillary segments before and after expansion. Methods: We measured dental landmarks on 21 study casts preoperatively and directly after expansion with tooth-borne or bone-borne rapid maxillary distraction. The three-dimensional differences in distraction between the two maxillary segments were calculated. Findings: In this study group, there was no significant difference in the symmetry/asymmetry of rapid maxillary expansion using a tooth-borne the two maxillary segments seem to have another cause i.e. the operation technique than the device used for distraction. The study group is continuously increased to gain further results.

New Technique for Mandibular Symphyseal Distraction by a Double-Level Anchorage and Fixation System: Advantages and Results.

A surgical technique to widen the mandible is the mandibular midline distraction: the most common indications for mandibular midline distraction are severe mandibular anterior crowding, severe mandibular transverse deficiency, uni- or bilateral crossbite, impacted anterior teeth with inadequate space, and tipped teeth. Commonly used distraction devices can be divided into 2 systems: bone-borne distraction system appliance, dental-borne distraction systems. Each system has peculiar advantages, disadvantages, and different indications. To combine advantages of both systems we developed a new technique adopting an immediate basal bone widening with fixation after osteotomy and a dental borne rigid lingual system for distraction. The aim of this work is to show a new technique for symphysis mandibular distraction based on a double-level anchorage and fixation system on clinical patients showing final results and advantages. Two patients affected by dento-alveolar and basal bone maxillary and mandibular transversal collapse even in association with other skeletal malocclusion were selected. Patients were clinically and radiographically studied and analyzed at different times before and after surgery. Dental and basal bone measurements were performed clinically and radiographically. The results were optimal with perfect dental arches alignment followed by closing of the open bites with multiple-segmented surgery in a second surgical time. No misalignment of the 2 mandibular halves was noticed during the distraction procedure. Dental-bone discrepancies correction is mandatory before orthodontic treatment alignment. Transversal jaw expansion can be achieved safely and stably by distraction of both maxillae for the combination of osteogenesis and histogenesis with augmentation of both bone and soft tissue. Bone-borne distraction will result in more stable results; dental-borne devices will result in more simple and aesthetically rewarding procedures. Hybrid techniques usually show mixed results depending on the characteristics of the device. For this reason we developed a combination of both the aforementioned systems which is not a hybrid system but the combination of an immediate expansion of the symphysis and fixation by 1 miniplate with only 2 screws acting like hinges during distraction, combined with a lingual distraction system at the alveolar bone level. Bone-borne distraction systems result in more efficient basal bone mandibular widening with increased stability for dental results. For dental-borne appliance the advantages consist in no second surgery need for their removal, no transmucosal hardware emergence and better aesthetic, especially when lingual devices were used. Our technique combines advantages of both procedures.

The Use of Bone-Borne Distractor for Correcting the Maxillary Transverse Discrepancy in an Adult Patient

Introduction: The objective of this study was to report the correction of a maxillary transverse discrepancy in an adult patient using Le Fort I osteotomy procedure associated with a bone-borne maxillary distractor device. Both the indications, advantages of the procedure and the use protocol were highlighted. Case Presentation: The results showed that the bone-borne distractor promoted the correction of maxillary transverse discrepancy with minimal side effects on the maxillary posterior teeth. Conclusions: The bone-borne maxillary distractor device is a good alternative for correcting the maxillary transverse discrepancy in patients undergoing Le Fort I surgery, especially in cases presenting either periodontal disease or gingival recession of maxillary posterior teeth.

Long-term (6.5 years) follow-up of mandibular midline distraction.

To assess the long-term stability and biomechanical effects of mandibular midline distraction (MMD), a prospective observational study was conducted with a retrospective cohort. Included were 17 MMD patients, of whom 9 completed the long-term follow-up with a mean of 6.5 years. In all patients, a bone-borne distractor was used. Dental casts and postero-anterior (PA) cephalograms were taken at fixed time points: pre-operative (T1), directly post-distraction (T2), 1-year post-operative (T3) and long-term follow-up (T4). Inter canine (ICD), inter first premolar (IPMD), inter first molar (IMD) distances and arch length (AL) were measured on dental casts. From the PA cephalograms intercondyle distance (ID) and the ramal angle (RA) were obtained. A significant and sustained widening was observed in most measurements. The greatest overall transverse expansion (T1-T4) occurred in the IPMD (4.1±0.76mm, P<0.05), the ICD, IMD and AL increased, respectively: 2.0±0.72mm, 3.8±0.82mm and 3.5±0.82mm. The ID did not change significant (P>0.05) during all phases of the study. An increase of RA was observed initially; however, no difference was noted in the long-term. This study showed that MMD is a stable method to expand the mandible, with no skeletal effect on the temporomandibular joint.

Maxillary changes with bone-borne surgically assisted rapid palatal expansion: A prospective study.

The aim of this prospective study was to analyze the postexpansion positional changes of the maxillary halves and their initial stability after transpalatal distraction with a bone-borne distractor and standard corticotomies of the anterior, lateral, and median bony supports of the maxilla without pterygomaxillary disjunction. The sample consisted of 21 patients (15 female, 6 male; mean age, 26years 5months). Measurements on the maxillary study casts and the posteroanterior cephalograms were obtained before surgery, at the end of palatal expansion, and 10weeks later. No orthodontic treatment was initiated during the examination period. After palatal expansion, significantly wider measurements were noted in the canine (35.5%), premolar (26.3%), and molar (17.8%) regions. Angulation changes in the premolar (-7°) and molar (-8°) segments were observed. No significant changes were seen between the end of palatal expansion and 10weeks later. Arch perimeter increased by 9.16% between presurgery and 10weeks after the end of expansion. The results indicated that more expansion was achieved anteriorly, and that there was buccal tipping of the split maxillary halves. Bone-borne surgically assisted rapid palatal expansion can provide significant expansion of the maxilla with an increase in arch perimeter, and it shows initial stability.

One-stage tooth-borne distraction versus two stage bone-borne distraction in surgically assisted maxillary expansion (SARME)

To evaluate and compare the effects of tooth-borne and bone-borne distraction devices in surgically assisted maxillary expansion (SARME) on dental and skeletal structures. A sample of 33 skeletally mature patients with transverse maxillary deficiencies was examined with cone beam computed tomography (CBCT) before and 3 months after surgery. Fourteen patients were treated with tooth-borne devices and 19 patients with bone-borne devices. Dental crown expansion in the first premolars did not differ significantly between the two groups, and median expansion was 5.55 mm (interquartile range [IQR] 5.23) in the tooth-borne device group and 4.6 mm (IQR 3.4) in the bone-borne device group. In the first molars, crown expansion and lateral tipping were significantly greater in the tooth-borne device group (P ≤ .02). The median skeletal nasal isthmus increase was significantly more in the bone-borne device group at 3.0 mm than in the tooth-borne device group at 0.98 mm (P ≤ .02). Both tooth-borne and bone-borne devices are effective treatment modalities to correct maxillary transverse deficiencies. Bone-borne devices produced greater widening of the skeletal nasal floor and fewer dental side effects in the first molars.

Does Transpalatal Distraction Affect Pharyngeal Airway Dimensions and Related Soft Tissues?

Previous studies of transpalatal distraction (TPD) have been based on dentoskeletal alterations of the jaws and nasal airway changes. The main aim of this study was to determine the effects of TPD on soft palate and pharyngeal airway dimensions and tongue posture. This was a retrospective cohort study. The sample was comprised of 16 patients with skeletal maxillary deficiency who had bilateral crossbite combined with a high palatal vault and partial or near total nasal obstruction treated with TPD using bone-borne distractors (Transpalatal Distractor, SurgiTec NV, Bruges, Belgium). This research was carried out on lateral cephalometric radiographs taken before distraction and after a distraction period of 6.75 ± 1.61 months. The primary predictor variable was pharyngeal airway dimensions and tongue posture. Other variables were demographic and lateral cephalometric parameters. Changes in the length, angle, and thickness of the soft palate; nasopharyngeal, retropalatal, retroglossal, and lower pharyngeal airway dimensions; and tongue length and height were evaluated. Data were analyzed by paired t test. The sample included 16 adult patients (mean age, 25.13 ± 6.13 yr; 7 women, 9 men). The desired amount of distraction was achieved in all patients within 7 to 10 days. The total activation average was 8.38 ± 0.96. TPD caused statistically significant changes in sagittal nasopharyngeal airway dimensions (1.19 mm), the minimal oropharyngeal distance behind the tongue base (1.81 mm), and tongue height (2.12 mm). The results of this study suggest that, in adult patients with nasal obstruction, TPD has the potential to increase sagittal nasopharyngeal airway dimensions and the minimal oropharyngeal distance behind the tongue, with an elevation in tongue posture. Further studies using cone-beam computed tomography that focus on how the bone-borne expander alters pharyngeal airway volume will make valuable contributions to the literature.

Volumetric changes of the nose and nasal airway 2 years after tooth‐borne and bone‐borne surgically assisted rapid maxillary expansion

This study aimed to assess the effects of bone-borne and tooth-borne surgically assisted rapid maxillary expansion on the volumes of the nose and nasal airway 2 yr after maxillary expansion. This prospective cohort study included 32 patients with transverse maxillary hypoplasia. Expansion was performed with a tooth-borne distractor (Hyrax) in 19 patients and with a bone-borne distractor [transpalatal distractor (TPD)] in the remaining 13. Cone beam computed tomography scans and three-dimensional (3D) photographs of the face were acquired before treatment and 22 ± 7 months later, and were used to evaluate the volumes of the nose and nasal airway. Nasal volume increased by 1.01 ± 1.6% in the Hyrax group and by 2.39 ± 2.4% in the TPD group. Nasal airway volume increased by 9.7 ± 5.6% in the Hyrax group and by 12.9 ± 12.7% in the TPD group. Changes in the nasal volume and in the nasal airway volume between the pre- and post-treatment measurements were statistically significant, whereas differences between the treatment groups were not; 22 months after surgically assisted rapid maxillary expansion, the increases in the nasal volume and in the nasal airway volume were comparable between tooth-borne and bone-borne devices.

Oral and dental restoration of wide alveolar cleft using distraction osteogenesis and temporary anchorage devices

Closure of large alveolar clefts and restoration by a fixed bridge supported by implants is a challenge in cleft alveolus treatment. A major aesthetic concern with distraction osteogenesis is obtaining a predictable position of the implant in relation to the newly generated bony alveolar ridge. We describe the treatment of a large cleft alveolus and palate reconstruction by distraction osteogenesis utilizing temporary anchorage devices (TADs) followed by a fixed implant-supported bridge. The method consists of segmental bone transport by distraction osteogenesis using a bone-borne distractor to minimize the alveolar cleft, followed by closure of the residual small defect by bone grafting three months later. During the active transport distraction, TADs were used exerting multidirectional forces to control the distraction vector forward and laterally for better interarch relation. A vertical alveolar distraction of the newly reconstructed bone of 15 mm facilitated optimal implant placement. The endosseous implants were osteointegrated and supported a fixed dental prosthesis.In conclusion, the large cleft alveolus defect was repaired in three dimensions by distraction osteogenesis assisted by TADs, and the soft tissues expanded simultaneously. Endosseous implants were introduced in the newly reconstructed bone for a fixed dental prosthesis enabling, rehabilitation of aesthetics, eating and speaking.

Three-dimensional evaluation of soft tissue changes in the orofacial region after tooth-borne and bone-borne surgically assisted rapid maxillary expansion

This study seeks to three-dimensionally assess soft tissue changes in the orofacial region following tooth-borne and bone-borne surgically assisted rapid maxillary expansion (SARME). This prospective cohort study included 40 skeletally mature patients with transverse maxillary hypoplasia. A tooth-borne distractor (Hyrax) was used for expansion in 25 patients. In the remaining 15, a bone-borne distractor (transpalatal distractor, TPD) was used. Cone beam computed tomography (CBCT) scans were acquired before treatment (T0) and 22 months later (T1). 3D models were constructed from CBCT data and superimposed using voxel-based matching. Distance maps between the superimposed 3D models were computed to evaluate the degree of skeletal and soft tissue changes in the maxillary region. Distance maps showed negative distances (mean -1.25 (±1.5) mm) in the middle of the upper lip, indicating posterior repositioning of this area. The cheek region showed positive changes (mean 1.66 (±1.1) mm), reflecting the underlying increase in maxillary width. There was no significant difference between the two groups in all measured distances (p > 0.05). Retro-positioning of the upper lip accompanied skeletal remodeling in the anterior alveolar region at a mean ratio of 88 %, while the cheek region followed 32 % of the alveolar expansion. Soft tissue changes following SARME include posterior repositioning of the upper lip and increased projection of the cheek area. These changes were comparable between bone-borne and tooth-borne appliances. This study provides clinicians with more information over the expected orofacial soft tissue changes following SARME.