Maxillary Expansion Procedure Research Articles

A Comprehensive Literature Review On Alternative Rapid Maxillary Expansion & Constriction Vs Conventional Rapid Maxillary Expansion Protocol In Protraction Facemask Therapy

The aim of this review article is to highlight the increasing popularity of Alt-RAMEC or Alternative Rapid Maxillary Expansion and Constriction procedure. It is a protocol used to correct the transverse maxillary discrepancy. In conjunction with facemask therapy, it can be used to correct the sagittal maxillary discrepancy in Class III malocclusion with a retrusive maxilla. Alt-RAMEC procedure was introduced by Liou in 2005 with the conclusion that the maxilla can be protracted more effectively through a repetitive weekly protocol of alternate expansion and constriction than with a single course of rapid maxillary expansion (RME). The article highlights the comparison of Alt-RAMEC maxillary expansion protocol with conventional RME protocol. This review will discuss the studies which include successful treatments by applying this protocol and differences with other methods.

Impact of Non-Surgical and Surgically Assisted Rapid Maxillary Expansion Procedures upon the Periodontium: A Systematic Review

Background: Scarce evidence is available regarding the occurrence and prevalence of hard/soft tissue deficiencies among patients undergoing surgically assisted rapid maxillary expansion (SARME) as compared to non-surgical rapid maxillary expansion (NSRME) approaches. The purpose of this study is to evaluate the effect of NSRME and SARME upon the periodontal structures. Methods: A literature search was performed to identify studies that fulfilled pre-established eligibility criteria, evaluating changes in the periodontium (e.g., probing depths) and hard/soft tissue deficiencies (e.g., bone levels, gingival recession) within patients undergoing NSRME and SARME procedures. Results: A total of 21 articles were included in the present review. Four of them evaluated the outcomes of both NSRME and SARME procedures, while six and eleven studies analyzed NSRME alone and SARME alone, respectively. The incidence of hard (e.g., changes in buccal bone width/height) and soft tissue deficiencies (e.g., gingival recession, keratinized tissue, and clinical attachment level) is slightly increased among patients undergoing maxillary expansion with worsened outcomes during NSRME procedures. Conclusions: The impact of NSRME and SARME upon the periodontium remains inconclusive.

Comparison of the effects of different rapid maxillary expansion techniques on craniofacial structures: a finite element analysis study

AimTo compare the effects of three different maxillary expansion appliances with five different types of expansion modalities on stress distribution and displacement on the maxilla and its adjacent craniofacial structures using the finite element method (FEM).Materials and methodsCone-beam computed tomography data of a patient with maxillary transverse deficiency were rendered into a three-dimensional model of craniomaxillary structures. The expansion appliances included tooth-borne, hybrid, and bone-borne expanders. Five different expansion modalities were applied to each expander [conventional Rapid Maxillary Expansion (RME) (type 1), midpalatal suture cortico-puncture-assisted RME (type 2), LeFort l cortico-puncture-assisted RME (type 3), surgically assisted RME (SARME) without pterygomaxillary junction (PMJ) separation (type 4), and SARME with bilateral PMJ separation (type 5)]. The numerical and visual data were analyzed.ResultsThe highest amount of stress accumulation on teeth was found in the tooth-borne and hybrid groups. On the other hand, more stress concentration on the maxilla was observed in the bone-borne group. SARME cuts with PMJ separation increased total movement by reducing the stress on the midpalatal suture in all groups. While types 1, 2, and 3 were similar in terms of the amounts of displacement, types 4 and 5 increased the total amount of displacement in all groups. The total amounts of displacements from the highest value to the lowest value for the anterior and posterior maxilla were in the bone-borne, tooth-borne, and hybrid groups.ConclusionsSARME cuts were effective in reducing stress on the teeth, but the cortico-puncture application affected neither the stress values on the teeth nor the transverse displacement in the tooth-borne expanders. Surgical procedures such as SARME and corticotomy should be used with bone-borne devices to improve the outcomes of maxillary expansion procedures.

Analysis of factors associated with the success of microimplant-assisted rapid palatal expansion

Success-related factors of microimplant-assisted rapid palatal expansion (MARPE) were evaluated, including age, palatal depth, suture, and parassutural bone thickness, suture density and maturation, and the relation to corticopuncture (CP) technique, as well as skeletal and dental effects. Sixty-six cone-beam computed tomography scans were analyzed before and after rapid maxillary expansion procedures in 33 patients aged 18-52 years for both sexes. The scans were generated in digital imaging and communications in medicine file format and analyzed in the multiplanar reconstruction of the regions of interest. Palatal depth, suture thickness, density and maturation, age, and CP were assessed. To evaluate dental and skeletal effects, the sample was divided into 4 groups: successful MARPE (SM), SM+ CP technique (SMCP), failure MARPE (FM), and FM+ CP (FMCP). Successful groups presented more skeletal expansion and dental tipping than failure groups (P<0.05). The mean age of the FMCP group was significantly higher than the SM groups; suture and parassutural thickness significantly related to the success, and patients who received CP showed a success rate of 81.2% compared with 33.3% in the no CP group (P<0.05). Suture density and palatal depth did not show a difference between the success and failure groups. Suture maturation was higher in SMCP and FM groups (P<0.05). Older age, thin palatal bone, and higher stage of maturation can influence the success of MARPE. CP technique in these patients appears tohave a positive impact, increasing the chance of treatment success.

The Prediction Accuracy of Digital Orthodontic Setups for the Orthodontic Phase before Orthognathic Surgery.

The purpose of this study was to verify whether pre-treatment digital setups can accurately predict the tooth positions after presurgical orthodontic treatment has been performed in a 3-dimensional way. Twenty-six patients who underwent a combined orthodontic-orthognathic surgical treatment were included. Pre-treatment digital dental models were merged with cone beam computed tomography (CBCT) scans. One operator fabricated virtual setups to simulate the tooth movements of the presurgical orthodontic treatment. Prior to surgery, digital dental models were merged with the CBCT scans. Differences between de virtual setups and the presurgical dental models were calculated using linear mixed model analyses. Differences in tooth displacements exceeding the boundaries of clinical acceptance (>2 degrees for rotations and >0.6 mm for translations) were found in 75% of the rotational and 52% of translational mean differences in the maxilla and in 74% of the rotational mean differences and 44% of the translational mean differences in the mandible. Significant differences were found for all tooth types and in all tooth displacement directions with significant effects of extractions and surgically assisted rapid maxillary expansion (SARME) procedures. The accuracy of the digital setup is still too limited to correctly simulate the presurgical orthodontic treatment.

Maxillary Expansion

Maxillary transverse insufficiency usually requires expansion of palate with a combination of orthopedic and orthodontic tooth movements. Four different types of maxillary expansion procedures are used: slow maxillary expansion (SME), rapid maxillary expansion (RME), miniscrew assisted rapid maxillary expansion (MARME), surgically assisted maxillary expansion (SARME). This article aims to review the maxillary expansion by all the rapid maxillary expansion modalities and a brief discussion on commonly used appliances.

Treatment Effect of Combined Surgical Maxillary Expansion and Mandibular Setback in Skeletal Class III

The purpose of this case report is to describe and discuss a combined surgical and orthodontic technique for the management of transverse maxillary deficiency and mandibular prognathism in the treatment of skeletal Class III malocclusion in a mature patient. Skeletal Class III malocclusion can present with maxillary deficiency or retrognathism, mandibular excess or prognathism, or a combination. The maxillary arch is narrow and often requires expansion. A 25-year-old patient presented with a constricted maxilla, a skeletal Class III malocclusion with a large mandible, Angle's Class III malocclusion, retroclined lower incisors, proclined upper incisors, crowding of maxillary and mandibular teeth, and bilateral posterior crossbite. The case report shows that an adult patient with Class III malocclusion (constricted maxilla and large mandible) can be treated with rapid maxillary expansion accompanied by bilateral maxillary osteotomies, followed by a reduction bilateral sagittal split osteotomy (BSSO). As the patient was 25 years old with a bilateral crossbite, a surgically assisted rapid maxillary expansion procedure was performed. As the diastema space was available at the end of expansion, it proved to be beneficial for the presurgical decompensation of Class III, thus creating a negative overjet, followed by which a BSSO setback was done.

Comparison of the Changes Following Two Treatment Approaches: Rapid Maxillary Expansion Versus Alternate Rapid Maxillary Expansion and Constriction.

The aim of the present study was to evaluate the hard and soft tissue changes following rapid maxillary expansion (RME) and alternate rapid maxillary expansion and constriction (Alt-RAMEC) therapies. A total of 54 patients who needed maxillary expansion or Alt-RAMEC procedure were recruited and divided into two groups (27 subjects in the RME group and 27 subjects in the Alt-RAMEC group). Expansion screw was activated 0.5 mm/day (2 turns/day) in the RME group. Approximately 11 mm of expansion was achieved. In the Alt-RAMEC group, the screw was activated 1 mm/day (4 turns/day) during a period of 4 weeks. In the first and third weeks, the screw was opened; in the second and fourth weeks, the screw was closed. Cephalometric tracing and analyzing were done with the aid of digital software. Lateral cephalometric radiographs were obtained before (T0) and after (T1) RME and Alt-RAMEC applications. In the RME group, the maxilla moved forward and downward. Upper incisor retrusion was observed according to the reference planes. In addition, the tip of the nose moved forward, and the upper lip moved downward. In the Alt-RAMEC group, the nasolabial angle became more obtuse, and the stomion superius moved backward and downward. RME therapy resulted in skeletal and dental changes in the maxilla and related structures, favoring a contribution to solving Class III problems. No remarkable changes were recorded in the Alt-RAMEC group.

The maxillary expansion procedures, the types, and the root resorption analysis methods

Transversal constriction of the maxilla is a common problem and may occur due to many reasons.The maxillary expansion procedures can be classified as rapid maxillary expansion (RME), semi-rapid maxillary expansion (SRME), and slow maxillary expansion (SME). In orthodontic treatment prosodure, it has been evaluated that it causes root resorption especially in the support teeth in many apparatus used for orthodontic treatment and in the expansion apparatus used in the treatment of transverse direction of maxilla. In this review, we aimed to evaluate maxiller expansion protocols and the methods of examining resorption in support teeth.&#x0D; &#x0D; How to cite this article: Topal R, Gündüz Arslan S. The maxillary expansion procedures, the types, and the root resorption analysis methods. Int Dent Res 2019;9(3):145-51.&#x0D; &#x0D; Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Complications in surgically assisted rapid maxillary expansion: a systematic review of the medical literature

Our aim was to perform a systematic open-access review of various complications reported for surgically assisted rapid maxillary expansion (SARME) procedures. There were 37 articles found in Pubmed using the search equation. Twelve articles were initially excluded according to the exclusion criteria. The 25 remaining articles were read in full for their descriptions of complications related to the SARME procedure in mature patients. The main reversible complications of SARME were infection, postoperative pain, and bleeding. There were also complications related to distractors, to secondary surgeries, and pterygomaxillary junction. The main non-reversible complications of SARME were associated with teeth, periodontal bone loss, and skull base fractures. Large field-of-view cone beam computed tomography (maxilla and skull base) should be implemented as initial planning tool to prevent many potential complications. The current trend for “minimally invasive” surgery in SARME might be, from an ethical point of view, transformed onto “minimally complicated” surgery as complication is still more harmful for any given patient than any potential perioperative surgical invasiveness.

Influence of interdigitation and expander type in the mechanical response of the midpalatal suture during maxillary expansion

Background and objectiveThe orthopedic Maxillary Expansion (ME) procedure is used for treating the transverse maxillary deficiency. This pathology consists in a smaller transverse dimension in the maxilla and leads to malocclusion. The treatment takes advantage of the existence of the midpalatal suture (MPS), which corresponds to the junction at the palatine bones of its horizontal portions. The technique employs a device, conventionally a palatal expander attached to the posterior teeth, to separate the two maxillary bones in the MPS. The objective of this study was to analyze, using the Finite Element Method, the biomechanical behavior of the MPS when an expansion is applied. MethodsA Computer Tomography image of the maxilla was reconstructed, the suture geometry was modeled with different interdigitation levels and types of hyrax devices. A total of 12 geometric models (three levels for interdigitation and four types of hyrax devices) were prepared and analyzed taking into account the chewing forces and the expansion displacement. For each case, maximum principal stresses on the maxilla (bone), and equivalent stresses on the expander device (stainless steel) were observed. In the MPS, maximum principal stresses and directional displacement were evaluated. ResultsThe results showed that the interdigitation does not have an important influence on the deformation behavior of the maxilla but it affects the stress distribution. In addition, the type of expander device and anchorage have a direct relationship with the treatment effectiveness; larger deformation in the expansion direction was obtained with skeletal when compared to dental anchorage. ConclusionsA study that allows a better understanding of the oral biomechanics during the application of ME was presented. To our knowledge, it is the first study based on computational simulations that takes into account bone structures, like maxilla and part of the skull, to analyze the interdigitation influence on the MPS behavior when exposed to a ME.

Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol: A Comprehensive Literature Review.

The aim of this comprehensive review is to introduce clinicians to the increasingly popularity Alt-RAMEC procedure, a method commonly used in the treatment of class III malocclusion in the last 15 years. Another application of the literature to enhance the skeletal effects of Class III treatment on the maxillae is the Alternative Rapid Maxillary Expansion and Constriction (Alt-RAMEC) procedure introduced by Liou, which improves the effectiveness of the maxillae relative to the surrounding sutures and the enhancement of the maxillae. In the Alt-RAMEC protocol, maxillae will be enlarged to be 1 mm per day, first enlarged to 7 mm, and then the 1 mm screw is closed. In other weeks, in this order the screw of the expansion device is turned on for one week and then closed for one week, completing the Alt-RAMEC protocol at the end of the 9-week process. In this review, we will discuss the advantages and disadvantages of the studies, which include successful treatments by applying this protocol, differences with other methods, its effect on the airway, and its advantages and disadvantages.

Osteo-regeneration personalized for children by rapid maxillary expansion: an imaging study based on synchrotron radiation microtomography

BackgroundPersonalized maxillary expansion procedure has been proposed to correct maxillary transversal deficiency; different protocols of stem cell activation have been suggested and rapid maxillary expansion (RME) is the most commonly used among clinicians. The present study aimed to quantify in three-dimensions (3D) the osteo-regeneration of the midpalatal suture in children submitted to RME.MethodsThree patients (mean age 8.3 ± 0.9 years) were enrolled in the study to preform biopsy of midpalatal suture. Two patients (subjects 1 and 2) were subjected to RME before biopsy. The third patient did not need maxillary expansion treatment and was enrolled as control (subject 3). Midpalatal suture samples were harvested 7 days after RME in subject 1, and 30 days after RME in subject 2. The samples were harvested with the clinical aim to remove bone for the supernumerary tooth extraction. When possible, maxillary suture and bone margins were both included in the sample. All the biopsies were evaluated by complementary imaging techniques, namely Synchrotron Radiation-based X-ray microtomography (microCT) and comparative light and electron microscopy.ResultsIn agreement with microscopy, it was detected by microCT a relevant amount of newly formed bone both 7 days and 30 days after RME, with bone growth and a progressive mineralization, even if still immature respect to the control, also 30 days after RME. Interestingly, the microCT showed that the new bone was strongly connected and cross-linked, without a preferential orientation perpendicular to the suture’s long axis (previously hypothesized by histology), but with well-organized and rather isotropic 3D trabeculae.ConclusionsThe microCT imaging revealed, for the first time to the authors’ knowledge, the 3D bone regeneration in children submitted to RME.

Modification of Transpalatal Arch for Expansion

Arch constriction is primarily corrected with either slow or rapid maxillary expansion procedures based on the nature of expansion desired. Clinical studies have suggested that slow expansion maintains sutural integrity during expansion, producing a more stable result than rapid maxillary expansion. Transpalatal arch (TPA) is a commonly used appliance for anchorage in maxillary arch and for controlling the position of molars. In this present article, we have described a simple modification of the commonly used TPA that can also function as a slow maxillary expansion appliance.

Evaluation of the effects of two different Alt-RAMEC procedures: five weeks versus nine weeks

Abstract Objective To evaluate and compare the skeletal, dentoalveolar and soft tissue effects of two different alternate rapid maxillary expansion (RMEs) and constriction (Alt-RAMEC) procedures. Material and methods Thirty-two consecutive patients presenting with a skeletal Class III malocclusion were placed into two comparative groups. Group 1 consisted of 16 patients (5 females and 11 males; mean age: 11.45 ± 1.87 years) who had an Alt-RAMEC procedure for five weeks and Group 2 consisted of 16 patients (6 females and 10 males; mean age: 11.52 ± 1.29 years) who had an Alt-RAMEC procedure for nine weeks. The parents of the patients were instructed to open the screw twice per day for one week and to close it twice per day for the following week (0.20 mm per turn). Nine angular and 20 linear cephalometric variables were measured. Results The groups were well matched in relation to patient gender distribution, chronological age and initial cephalometric values. Both Alt-RAMEC procedures showed similar effects with no statistically significant differences. The maxillae moved slightly forward and the mandible moved slightly downward, the changes of which caused an improvement in the maxillo-mandibular relationship in both groups. The overjet slightly increased and the overbite decreased in both groups. The upper lip moved slightly forward during the nine-week treatment Alt-RAMEC group. Conclusion Despite the favourable and similar effects of both procedures, neither seems to be sufficient for the complete correction of a skeletal Class III malocclusion.

Does stinging nettle (Urtica dioica) have an effect on bone formation in the expanded inter-premaxillary suture?

ObjectiveTo determine whether systemically given stinging nettle (SN) has an effect on bone formation in response to expansion of the rat inter-premaxillary suture. Materials and methodsA total of 28 male Wistar albino rats were randomly divided into 4 equal groups: control (C), only expansion (OE), SN extract given only during the expansion and retention periods (SN group; a total of 17days), and SN extract given during the nursery phase before expansion (a period of 40days) and during the expansion and retention periods (N+SN group; a total of 57days). After the 5-day expansion period was completed, the rats in the OE, SN, and N+SN groups underwent 12days of mechanical retention, after which they were sacrificed, and their premaxilla were dissected and fixed. A histologic evaluation was done to determine the number of osteoblasts, osteoclasts, and capillaries, as well as the number and intensity of inflammatory cells and new bone formation. ResultsStatistically significant differences were found between the groups in all histologic parameters except the ratio of intensities of inflammatory cells. New bone formation and the number of capillaries were significantly higher in the SN groups than in the other groups. The statistical analysis also showed that the numbers of osteoblasts, osteoclasts, and capillaries were highest in the N+SN group. ConclusionSystemic administration of SN may be effective in accelerating new bone formation and reducing inflammation in the maxillary expansion procedure. It may also be beneficial in preventing relapse after the expansion procedure.

The reliability of using postero-anterior cephalometry and cone-beam CT to determine transverse dimensions in clinical practice

Abstract Aim: This study primarily aimed to assess the accuracy of classically-advocated reference points for the measurement of transverse jaw-base and dental relationships using conventional Postero-Anterior Cephalometry (PAC) and Cone-Beam Computed Tomography (CBCT). Method: PAC and CBCT images were collected from 31 randomly selected orthodontic patients (12 males, 19 females), all of whom had a full permanent dentition. The transverse widths of the maxilla, mandible and the dentition were measured using reference points on both image modalities. Confidence intervals, intra-class coefficients and Bland Altman plots were used to assess the measurement differences derived from the two acquirement methods. Results: Measurements on PAC and CBCT images demonstrated statistically significant differences in the majority of the assessed variables. The interjugal (J-J) width was one of only two variables which did not demonstrate a statistically significant difference on image comparison. The mean differences of the antegonial width (Ag-Ag) (-4.44mm, 95% CI -5.38 to -3.51) represented the greatest difference between the imaging techniques. The application of these points to a transverse skeletal analysis (J-J/Ag-Ag ratio) revealed that five of the 31 subjects (16%) recorded ‘false positive’ readings according to the derived data. Conclusion: It is recommended that clinicians are cautious when interpreting and making decisions related to transverse dimensions derived from a PAC. The PAC has a higher tendency to falsely identify individuals who require maxillary expansion procedures based on conventional clinical criteria. The errors primarily associated with identifying structures which represent the width of the mandible are significant in both PAC and CBCT techniques and require further investigation. It is postulated that the confounding effects of overlying soft tissues have a significant impact on a clinician’s ability to identify relevant landmarks.

Maxillary expansion by nickel titanium palatal expander in cleft palate patient

Transverse expansion of the maxilla has been used by orthodontists for more than 100 years to correct maxillary anomalies. Rapid mechanical maxillary expansion procedures as presently employed, utilize large loads designed to produce a maximal skeletal repositioning with a minimum of individual tooth movement whereas tandem-loop nickel titanium NiTi, temperature-activated palatal expander with the ability to produce light, continuous pressure on the midpalatal suture. This case report describes the management of a 15-year-old girl with repaired cleft lip and palate, skeletal class III which exhibited mild maxillary deficiency. Dental examination revealed class I molar relation with reverse overjet, bilateral posterior crossbite, and constricted maxillary arch. A combination of various radiographs was used to diagnose and plan the treatment for maxillary expansion. The expander was assembled with bands as one unit and secured with elastic modules. During the 3 months study period, no other treatment was performed. An increase of 4 mm in intermolar width, 2 mm in intercanine width, and 4 mm in interpremolar width was achieved. The NiTi expander provides a viable alternative to rapid expansion for correction of transverse discrepancies.

Volumetric upper airway assessment in patients with transverse maxillary deficiency after surgically assisted rapid maxillary expansion

Transverse maxillary deficiency is commonly found in patients with sleep apnea and is also related to abnormal breathing patterns. Maxillary expansion procedures promote widening of the nasal floor and reduce the resistance to airflow, and have a positive influence on nasopharynx function. In order to evaluate volume changes in the upper airway, 15 adult patients with transverse maxillary deficiency underwent surgically assisted rapid maxillary expansion (RME) until a slight overcorrection of the crossbite was obtained. Cone beam computed tomography (CBCT) volumetric images were obtained at three predefined time points. The mean age of the patients was 30.2 (±7.4) years; nine were females and six were males. The area, volume, and the smallest transverse section area of the airway were assessed using Dolphin Imaging 3D software. Statistical comparisons were made of the changes between time periods. No statistically significant differences were found for volume or area. However a significant difference was found between the preoperative and immediate postoperative smallest transverse section area (P<0.05). Maxillary expansion, as an isolated procedure, does not result in a statistically significant improvement in the airway dimensions and results in an inferior relocation of the smallest transverse section area.

Effect of a low-level laser on bone regeneration after rapid maxillary expansion

In this study, we evaluated the effects of a low-level laser on bone regeneration in rapid maxillary expansion procedures. Twenty-seven children, aged 8 to 12 years, took part in the experiment, with a mean age of 10.2 years, divided into 2 groups: the laser group (n = 14), in which rapid maxillary expansion was performed in conjunction with laser use, and the no-laser group (n = 13), with rapid maxillary expansion only. The activation protocol of the expansion screw was 1 full turn on the first day and a half turn daily until achieving overcorrection. The laser type used was a laser diode (TWIN Laser; MMOptics, São Carlos, Brazil), according to the following protocol: 780 nm wavelength, 40 mW power, and 10 J/cm(2) density at 10 points located around the midpalatal suture. The application stages were 1 (days 1-5 of activation), 2 (at screw locking, on 3 consecutive days), 3, 4, and 5 (7, 14, and 21 days after stage 2). Occlusal radiographs of the maxilla were taken with the aid of an aluminum scale ruler as a densitometry reference at different times: T1 (initial), T2 (day of locking), T3 (3-5 days after T2), T4 (30 days after T3), and T5 (60 days after T4). The radiographs were digitized and submitted to imaging software (Image Tool; UTHSCSA, San Antonio, Tex) to measure the optic density of the previously selected areas. To perform the statistical test, analysis of covariance was used, with the time for the evaluated stage as the covariable. In all tests, a significance level of 5% (P <0.05) was adopted. From the evaluation of bone density, the results showed that the laser improved the opening of the midpalatal suture and accelerated the bone regeneration process. The low-level laser, associated with rapid maxillary expansion, provided efficient opening of the midpalatal suture and influenced the bone regeneration process of the suture, accelerating healing.