Maxillary Expansion In Adults Research Articles

Effects of different expansion appliances and surgical incisions on maxillary expansion: A finite element analysis

PurposeThis study aims to assess the impact of different surgical techniques and three expansion appliances on maxillary expansion in adults using finite element analysis (FEA), with a focus on maxillary displacement and stress on surrounding structures. MethodsSeven different FEA models were created to compare different surgical techniques and three different expansion appliances. Model I represented a bone-supported appliance without surgical assistance. Model II, Model III, and Model IV were surgically assisted rapid palatal expansion (SARPE) models without pterygomaxillary suture disjunction (PMD). Model V, Model VI, and Model VII were SARPE models with PMD. ResultsThe largest displacement at the anterior nasal spine (ANS) was recorded for Model II (2.95 mm). For the posterior nasal spine (PNS), the highest displacement was observed in Models V, VI, VII (2.50 mm), with the lowest in Model III (0.79 mm). Stress analysis revealed the highest stress in Model I, with models featuring PMD displaying nearly zero stress at all anatomical points, highlighting distinct expansion patterns and stress distributions between models with and without PMD. ConclusionSARPE models with PMD demonstrated a parallel expansion of the maxilla with minimal stress, while the miniscrew assisted rapid maxillary expansion (MARPE) model displayed transverse rotation. SARPE models without PMD exhibited a V-shaped expansion pattern. SARPE models with PMD represent an optimal approach for achieving uniform expansion and minimizing stress, with stress levels nearly negligible at all anatomical points in models with PMD.

Three-dimensional evaluation of the temporomandibular joints after unilateral surgically assisted rapid maxillary expansion in adults: A preliminary retrospective study.

Unilateral surgically assisted rapid maxillary expansion (U-SARME) is a successful method for correction of true unilateral posterior crossbite (TUPC). This retrospective preliminary study aimed to evaluate the position and morphology of condyles in TUPC cases and the effects of U-SARME on condyle with the help of cone beam computed tomography (CBCT). Fifteen patients (mean age: 18.69 ± 1.59 years) who were diagnosed as TUPC and undergone U-SARME were selected. Preoperative (T0) and after 6-month retention (T1) DICOM data of CBCT images were evaluated with MIMICs version 19.0 software. Condylar morphology (medio-lateral and antero-posterior dimensions) and position (anterior, posterior, medial and lateral joint spaces, frontal/axial axis angles, the ratio of posterior to anterior joint space and the percentage of posterior to anterior joint space) were evaluated. Student's t-test was used for intergroup (crossbite, normal) comparisons. Paired-samples t-test was used for intra-group comparisons (p = .05). There were no positional or dimensional asymmetry of the condyles between crossbite and normal sides initially and after expansion. Regarding T0-T1 changes, while significant increase was determined in medial (0.3 ± 0.29 mm; p = .001) and superior (0.39 ± 0.7 mm; p = .045) joint spaces on crossbite side, posterior (0.79 ± 0.99 mm; p = .008), superior (0.5 ± 0.79 mm; p = .029) and lateral joint spaces (0.31 ± 0.54 mm; p = .042) presented significant increases on normal side. However, no significant changes were found between crossbite and normal sides at T0 and T1. Condyles were symmetrical in true unilateral posterior crossbite cases and the symmetry were not disrupted following U-SARME.

Does surgically assisted maxillary expansion improve obstructive sleep apnoea in adults? A systematic review and meta-analysis.

Introduction The aim of this systematic review and meta-analysis was to evaluate the effects of maxillary expansion on adults with obstructive sleep apnoea (OSA).Methods Electronic searches up to July 2021 in eight electronic databases were conducted. Study selection, data extraction, risk of bias evaluation using ROBINS-I, quality of evidence assessment using GRADE and meta-analyses were performed.Results The electronic searches yielded 1,007 studies. Following the application of the eligibility criteria, 15 articles were fully read and five studies were included. The studies evaluated the effects of surgically assisted rapid maxillary expansion in adults with OSA. The meta-analysis demonstrated an improvement in Apnoea-Hypopnea Index (AHI) (MD = -9.91, CI = -14.57 to -5.25), Oxygen Desaturation Index (ODI) (MD = -7.95, CI = -12.23 to -3.67), and Epworth Sleepiness Scale (ESS) (MD = -4.40, CI = -6.39 to -2.40). ROBINS-I indicated serious, no information and critical risk of bias for the included studies. The quality of the evidence was very low.Conclusion The findings herein suggest that maxillary expansion could improve OSA in adults in the short term.

Three-dimensional palatal morphology and upper arch changes following nonsurgical and surgical maxillary expansion in adults

The objective of this study was to evaluate the effects of nonsurgical rapid maxillary expansion (RME) and surgically assisted RME (SARME) on palatal morphology and upper arch dimensions using three-dimensional (3D) models in skeletally mature patients. Thirty-eight skeletally mature patients with a maxillary transverse deficiency were divided into RME and SARME groups. Nineteen patients in the RME group (mean age, 19.16 ± 2.25 years) were treated using a full-coverage bonded acrylic splint expander; 19 patients in the SARME group (mean age, 20.38 ± 3.36) were treated using the banded palatal expansion appliance with hyrax screws. The 3D models were obtained before and after expansion. The maxillary dental arch widths, maxillary first molar angulation, palatal area, and palatal volume were calculated on the 3D models. All variables showed statistically significant changes after the retention period (P < .001). The maxillary arch width between first premolars (P < .05), the palatal area (P < .01), and the palatal volume (P < .05) significantly increased in the SARME group compared to the RME group. The maxillary first molar tipping in the RME group was significantly higher than that in the SARME group (P < .01). Although SARME has more positive effects in skeletally mature patients, nonsurgical RME can be considered as an alternative by evaluating surgical risks, periodontal status, and the need for skeletal expansion.

Surgically Assisted Rapid Palatal Expansion as A Treatment for Maxillary Expansion in Adults: A Review

Transverse Maxillary Deficiency is a common dental malocclusion that usually presents as constricted maxilla with both functional as well as esthetic effects on the individual suffering from it. Functional appliance can be used in children whose mid palatal suture has not ossified but adults required surgical approach such as surgically assisted rapid palatal expansion. We conducted a literature review of techniques of surgical rapid maxillary expansion, appliances commonly used for expansion and finally the complications associated with it postoperatively. Review of available literature was conducted using literature present in PubMed, Google scholar, ESCO and semantic scholar using the following keywords in combination such as “Surgically assisted rapid palatal expansion”, Hyrax appliance” “Haas Appliance” and “Transverse Maxillary Deficiency”. Out of the 210 articles screened, 40 were included in this literature review. Presently, surgically assisted rapid maxillary expansion is a treatment option for patients in their adulthood in which the mid-palatal suture has been closed. Expansion appliances such as Haas and Hyrax are used adjunctively with surgical modalities.

Treatment of a Growing Patient with Skeletal Class III Malocclusion Using Face Mask and Maxillary Skeletal Expander

Face mask treatment with a rapid palatal expander is common in children with Class III malocclusion and maxillary deficiency. However, it can cause anchorage loss and dental side effects. To overcome these disadvantages, the use of skeletal anchorage such as miniplates in the infrazygomatic crest area or palate has been reported. This clinical case report presents face mask treatment in skeletal Class III adolescent with maxillary skeletal expander (MSE). MSE has been developed for the maxillary expansion in adults, but it can be used as a skeletal anchorage for face mask treatment in children. The post-treatment profile was significantly improved without any dental side effects.

Skeletal Changes Accompanying Surgically Assisted Rapid Maxillary Expansion in Adults A Computed Temography Evaluation

Background: Surgically assisted rapid maxillary expansion (SARPE) is a common procedure to correct maxillary transverse deficiency of &gt;5mm in patients with closed midpalatal suture. The aim of this study was to three dimensionally analyze skeletal changes afterSARPE.Studydesign: Twelve adult patients (mean age 20 years)with a palatal transverse deficiency underwent SARPE. The surgical procedure consisted of a lateral osteotomy combined with an interradicular osteotomy between the roots of the upper central incisors. Measuring points were defined on the hard palate. Cone beam computerized tomography scans were performed preoperatively and 6-months postoperatively.Results: Skeletal changes accompanying SARPE utilizing Hyrax appliance were analyzed.Conclusions: Bilateral osteotomy combined with a sagital osteotomy is a safe method of SARPE. The expansion was mostly achieved by maxillary expansion. The amount of dentoalveolar tipping was smaller than reported.

Maxillary Protraction with Miniscrew Assisted Rapid Palatal Expander in Children with Skeletal Class III Malocclusions

Protraction headgear therapy with a rapid palatal expansion appliance used as an intraoral anchorage is common in children with Class III malocclusion and maxillary deficiency. However, it can show anchorage loss or failure of protraction in older age children. Therefore, some clinicians proposed the use of skeletal anchorage such as miniplates in the infrazygomatic crest area or miniscrews in the palate. These case reports describe maxillary protraction therapy in children with the miniscrews assisted rapid palatal expander (MARPE). At first, MARPE has been developed for the maxillary expansion in adults, but it could also serve as a good skeletal anchorage for protraction therapy in children.

Activation Intervals Effects on Non-surgical Maxillary Expansion in Adults

Activation Intervals Effects on Non-surgical Maxillary Expansion in Adults

Nonsurgical maxillary expansion in adults: report on clinical cases using the Hyrax expander.

Maxillary expansion in adults is object of intense controversy and is still considered an unreliable procedure within the orthodontic community. Therefore, the surgically assisted rapid maxillary expansion is still considered the elective treatment nowadays. The aim of this study is to evaluate the efficacy of a nonsurgical maxillary expansion treatment in adult patients with unilateral or bilateral crossbites and to assess the occurrence of related complications, such as pain and tissue swelling, tipping of the posterior teeth and gingival recessions. Maxillary expansion using a Hyrax appliance on the upper first premolars and first molars was performed in 29 patients ranged between 18 and 32 years, mean age of 22±4 years. The sample included 13 patients with unilateral crossbite and 16 with bilateral crossbite. The statistical analysis was carried out using the SPSS Statistics version 23.0. An analysis of the paired data obtained on dental casts before and after treatment was performed using the Student's t-test. The posterior crossbite was fully corrected in all patients. The procedure was well tolerated, and pain, swelling or discomfort was not significant. Statistically significant differences were found between the interdental widths for all pairs, with a P<0.001 for all of them, except in the measurements of canines, in which P=0.001. Measurements of clinical crown height at the beginning (T0) and at the end (T1) of treatment were performed for the same teeth. An increase of the clinical crown height between 0.14 and 0.44 mm was found for premolars and molars. The results indicate that nonsurgical maxillary expansion in adult patients is an efficient method for correcting transverse deficiency in the maxillary arch. Similarly, the level of complications during treatment was not clinically significant, thus this procedure may be considered a safe treatment.

Evaluation of transverse dental changes after surgical assisted rapid maxillary expansion in adults

Objectives: Surgical assisted rapid maxillary expansion (SARM can affect both skeletal and dental shape and soft tissue the size of the nasal passages and airway resistance, favoring improved nasal respiration. Aim: The aim of this study was to evaluation of transverse dental changes after surgical assisted rapid maxillary expansion in adults. Patients and Methods: The present study was carried out to clinically assessment of the surgical assisted rapid maxillary expansion. Nine healthy adult patients were used in this study. Surgical assisted rapid maxillary expansion was done. Patients were subjected to evaluation by study models. Results: Results of the current study have indicated that surgical assisted rapid maxillary expansion values of study models were higher. Conclusion: study models may be effective in clinically assessment of surgical assisted rapid maxillary expansion.

Adjunctive buccal and palatal corticotomy for adult maxillary expansion in an animal model.

ObjectiveThis study aimed to explore the usefulness of adjunctive buccal and palatal corticotomy for adult maxillary expansion in an animal model using cone-beam computed tomography (CBCT).MethodsTwelve adult sheep were randomly divided into two groups (each n = 6): a control group, where no treatment was administered, and a treatment group, where buccal and palatal corticotomy-assisted maxillary expansion was performed. CBCT scans were taken before (T1) and after (T2) treatment. Differences in all transverse dental and alveolar dimensions, alveolar width at crest level, hard palate level, horizontal bone loss, interdental cusp width and inter-root apex were assessed using Wilcoxon signed-rank and Mann-Whitney U-tests. Kruskal-Wallis tests and pairwise comparisons were used to detect the significance of differences among the inter-premolar and inter-molar widths.ResultsCBCT data revealed significant changes in all transverse dental and alveolar dimensions. The mean interpremolar alveolar width showed an increase of 2.29 to 3.62 mm at the hard palate level, 3.89 to 4.38 mm at the alveolar crest level, and 9.17 to 10.42 mm at the buccal cusp level. Dental changes in the vertical dimension were not significant.ConclusionsOur findings based on an adult animal model suggest that adjunctive buccal and palatal corticotomy can allow for both skeletal and dental expansion, with the amount of dental expansion exceeding that of skeletal expansion at alveolar crest and hard palate levels by two and three folds, respectively. Therefore, this treatment modality is potential to enhance the outcomes of maxillary expansion in adults.

Rapid maxillary expansion in adults: Can multislice computed tomography help choose between orthopedic or surgical treatment?

The aim of this study was to evaluate the accuracy of Multislice Computed Tomography (MSCT) in the detection resistance areas on the midpalatal suture (MPS) and thus to evaluate if MSCT could be a help in the kind of maxillary expansion to be used (pure orthodontic or surgically-aided) for the correction of transverse maxillary deficiencies in adults. Ten MSCT were obtained from 10MPS removed from fresh corpses (mean age: 79.4; extreme: 70-86). Three standardized radiological regions of interest (ROI) were identified on each MPS and were classified into "open" (group 1) or "closed" (group 2) by 3 independent radiologists. The 30ROI were then histologically analyzed according to 3 criteria: mean suture width (MSW), obliteration index (OI) and interdigitation index (Ii). Nine ROI were classified in group 1 (closed) and 21 in group 2 (open). On the histological examination, the mean MSW was 396.9μm in group 1 and 227.1μm in group 2. OI was 3.098% and 9.309% and Ii was 1.25 and 1.34 respectively. Statistically significant difference between the 2groups was only found for the MSW. We conclude that MSCT allows for the evaluation of the width of the MPS, but not for the evaluation of the other possible parameters of resistance we used. Therefore, it cannot predict precisely the amount of résistance in the MPS and is not suited for the choice between pure orthodontic or surgically-aided expansion.

Nonsurgical Maxillary Expansion in Adults: Report of Two Cases

Correction of maxillary transverse discrepancy requires expansion of palate by combination of orthopedic and orthodontic movements. Isolated maxillary transverse deficiency can be treated either orthodontically or surgically with assisted rapid maxillary expansion (RME). Nonsurgical expansion modalities include rapid maxillary expansion and slow maxillary expansion. Haas popularized the idea of orthodontic palatal expansion in the 1960s, and since then transverse deficiencies have been treated successfully in children and adolescents. The use of palatal expanders in adults was widely frowned upon and was generally considered to be unsuccessful. Handelman published a clinical review in 1997, proving a nonsurgical expansion in adults was possible.

Use of a Modified Expander During Rapid Maxillary Expansion in Adults: An In Vitro and Finite Element Study

This preliminary study was performed to evaluate a proposed maxillary expansion treatment method for adults with fused intermaxillary sutures. This study was performed in three Thiel-fixed skulls from older female cadavers with a microimplant-supported expansion screw. This modified expansion screw was mounted on the palatine process with microimplants and activated every 15 to 20 seconds with an activation key until the intermaxillary suture ruptured. A strain gauge was bonded to the expansion screw and calibrated so it could be used as a force sensor device. Rupture of the intermaxillary suture was indicated by a sudden drop in the registered force, through visible opening of the suture, and via computed tomographic data. Finite element simulations were performed, which led to the experimental testing. Rupture of the intermaxillary suture was achieved in all three experiments with the microimplant-supported screw. The strain measurement on one of the expansion screws resulted in an expansion force of 86 N. Finite element simulations showed a high tensile stress concentration exerted by the microimplant-supported expansion screw on the intermaxillary suture. The applied expansion force led to high tensile stress concentrations, mainly on the intermaxillary sutures, resulting in the opening of fused intermaxillary sutures. This method may help adults to be treated by an orthodontist, thereby avoiding surgical intervention.

Controversies about Midpalatal Suture and Maxillary Expansion: Literature Review

Introduction: what does forms the midpalatal suture (MS)? Which are its functions? In which period of life its obliteration occurs? In addition to these questions, literature often disagrees about several details associated to the maxillary transversal deficiency treatment through orthopedic expansion. Recent researches have show results that help to understand the physiology and behavior of MS during and after maxillary expansion, both in the pre as post pubertal period. What leads, in some cases, to an absolutely different interpretation of aspects that were presented by relevant papers previously published. New foreground about the MS, at various points, contrast with old concepts. Objective: the present work aimed to analyze previous data and suppositions in order to elucidate the possibility of MS total obliteration after puberty, the influence of mineral density at the MS region during the maxillary expansion process and the role of age in the maxillary expansion process. Conclusion: The hypothesis that in some point of life there will be a full obliteration of the MS probably could be abandoned, because it does not match with recent literature data and with the physiological behavior presented by the MS. Nevertheless, the MS mineral density, which varies with the age of the individuals, may be capable to interfere in the bone repair physiological capability and in the sutural elasticity. The MS mineral density high rates, once described as usual in middle aged individuals, may be the responsible for the contraindication of maxillary expansion in adults.

Cephalometric study of slow maxillary expansion in adults

The purpose of this retrospective study was to evaluate the dentoskeletal changes after slow maxillary expansion in adults. Three kinds of maxillary expanders (Haas [Dyna Flex, Laboratory, St Louis, Mo], MAX-2000 [Dyna Flex], and DMAX-2000 [Dyna Flex]) were used randomly in 3 study groups of 65 adults treated with nonsurgical slow maxillary expansion, followed by full straight-wire appliance therapy. A control group of 22 adults, meeting the same inclusion criteria, were treated only with full straight-wire appliance therapy without expansion. Posteroanterior and lateral cephalometric records were taken before the start of treatment (T1) and after fixed orthodontic treatment (T2). The data were analyzed statistically by using paired t tests and Kruskal-Wallis H tests. From T1 to T2, there was no significant change in nasal width, maxillary width, and mandibular width in the 3 groups. The sella-nasion-mandibular plane angle increased 0.97 degrees (P <0.05) in the DMAX-2000 group. The mandibular incisor-mandibular place angle in the Haas, MAX-2000, DMAX-2000, and control groups had mean increases of 4.90 degrees, 4.42 degrees, 4.55 degrees, and 5.20 degrees (P <0.05 for each), respectively. The maxillary incisor-nasion-A-point angle increased 3.04 degrees (P = 0.05), and the distal root of the maxillary first molar-nasion perpendicular decreased 1.48 mm (P <0.05) in the control group. The distal facet of the maxillary first molar-nasion perpendicular decreased 3.57 mm (P <0.05), and the distal root of the maxillary first molar-nasion perpendicular decreased 2.50 mm (P <0.05) in the MAX-2000 group. After expansion treatment, there were no evident transverse or significant sagittal and vertical skeletal maxillary changes in the 3 groups.

Surgically assisted maxillary expansion in adults: prospective study

The purpose of this research was to carry out a prospective clinical study of patients with transverse maxillary deficiency, orthopaedically expanded after minimum osteotomies of the zygomatic pillars and the median palatine suture, with quantitative assessment of the stability of the transverse dimensions of the maxilla. The distance between the superior canines and the first superior molars was measured six times during the clinical experiment. The desired expansion was achieved by 15 days postoperatively for all patients. After one year of follow-up, clinical measurements showed a relapse rate of 23% in the superior canine area and 18% in the superior first molar area.

Rapid maxillary expansion in adults: cranial stress reduction depending on the extent of surgery

The objective of this study on surgically assisted rapid maxillary expansion (RME) was to examine the extent of stress reduction in the midface and the cranial base with various surgical procedures. Four finite element models of the skull were generated (one without and three with different surgical incisions), in which a virtual RME (5 mm gap width) was simulated. In all four simulations, von-Mises stresses were measured at 30 anatomical structures of the midface and cranial base (in MPa) and compared. The highest von-Mises stresses were measured with the model that did not involve any osteotomies. A reduction of the observed stresses was found after isolated weakening of the zygomaticoalveolar crest on both sides. The model with a complete lateral osteotomy from the piriform aperture to the pterygopalatal junction clearly showed lower stresses than the model with isolated weakening of the zygomaticoalveolar crest. The lowest stress values, however, were seen on the model with a complete osteotomy at the Le Fort I level. In order to prevent complications at the cranial base, surgical assistance is an important aspect of RME in adults. The extent of osteotomies can be varied. The older the patient and the less the bone elasticity, the more extensive should be the surgical weakening in order to minimize the stresses induced at the cranial base and the midface. In older patients, a complete lateral osteotomy from the piriform aperture to the pterygopalatal junction seems to reduce stresses at the cranial base more effectively than isolated weakening of the zygomaticoalveolar crest.

Surgically assisted, rapid maxillary expansion in adults. A retrospective long-term follow-up study

This study presents a technique for surgically assisted, rapid maxillary expansion performed on 20 patients and the results after orthodontic treatment. The mean age of the patients was 36.3 years and on average they had been followed-up for 3 years and 6 months. The results seemed to be reliable long-term. The definitive expansion in the first molar region was 7.1 mm +/- 2.4 and in the canine region 4.8 mm +/- 2.7. The relapse measured after the observation period, was in the corresponding regions 1.2 mm +/- 1.3 and 0.2 mm +/- 2.1. The study also seemed to support the theory that the suture, anterior to the incisive canal, never ossifies until very late in life.