Maxillary Transverse Discrepancy 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.

Comparative efficacy of microimplant-assisted rapid palatal expansion versus surgically assisted rapid palatal expansion in the treatment of maxillary transverse discrepancy

Background: The maxillary transverse discrepancy is an arch-length reduction that has an unsatisfactory effect on the aesthetics of the face and position while resulting in functional damage. Because of these variations, the goal of this study is to assess the efficacy, stability, and potential adverse effects of Microimplant-Assisted Rapid Palatal Expansion (MARPE) and Surgically Assisted Rapid Palatal Expansion (SARPE) in MTD in adolescents and adults. Methods: An electronic search was conducted in five distinct databases, and the findings contained only peer-reviewed literature from 2018 to 2024. Randomised controlled studies comparing the efficacy of MARPE and SARPE in inducing skeletal and dental alterations, treatment stability, and relapse rates were among the study selection criteria. Data extraction included a review of patient demographics, types of therapies provided, outcomes obtained, and side effects noted. Results: The findings of the study demonstrate that both procedures are appropriate for the treatment of MTD, but MARPE provides advantages in terms of morbidity and patient satisfaction, whilst SARPE may provide faster and more stable outcomes in some circumstances. This study encourages doctors to consider individual patient needs before determining which maxillary transverse discrepancy treatment strategy to use. Conclusion: This study discovered that the MARPE has superior skeletal results and stability than the SARPE, albeit with a higher risk of surgical complications. It is critical to ensure that the unique patient population is carefully selected.

Maxillary transverse discrepancy: Latest innovations in diagnosis and treatment planning

Transverse length related malocclusions are common in orthodontic clinics. They can be as simple as posterior crossbite or as severe as Class III malocclusion, where the jaw is asymmetrical. Cases of lateral malocclusion range from simple alveolar problems to complex problems such as bone asymmetries that occur after adolescence and lead to temporomandibular joint disorder (TMD). This is a review article to discuss types of transverse malocclusions and most latest innovations in diagnosis and treatment planning. Many methods of diagnosis and correcting maxillary transverse discrepancies have been discussed. Orthodontists should know about the drawbacks of each method.

A Comprehensive Review of the Techniques and Outcomes of Various Maxillary Expansion Approaches

The present comprehensive review focuses on maxillary expansion techniques, with a particular emphasis on Rapid Maxillary Expansion (RME). The study aims to compare the effectiveness, stability, and various techniques in adults with skeletal maxillary transverse discrepancies. The review discusses maxillary expansion concepts, appliances, forces, mechanisms, and the dental, skeletal, and nasal impacts. It also examines the challenges associated with traditional RME in adult patients and explores advancements in surgical procedures to address these challenges. The current review emphasizes Surgically Assisted Maxillary Expansion (SARME) as a successful and more stable treatment approach for adults requiring palatal expansion, minimizing tooth tipping, and optimizing skeletal correction.

Comparison of maxillary transversal changes between auxiliary beta-titanium expansion arch and miniscrew-assisted rapid palatal expansion.

This study compared buccal bone thickness, dental inclinations and maxillary transverse width dimensions changes between auxiliary beta-titanium expansion arch (AEA) and miniscrew-assisted rapid palatal expansion (MARPE). The sample consisted of 29 patients, aged between 18 and 40 years, with transverse maxillary deficiency and treated without extractions, divided into two groups: group AEA: comprised 13 individuals (initial mean age: 29.23 ± 9.13 years) treated using auxiliary beta-titanium expansion arch; group MARPE: comprised 16 patients (initial mean age: 24.92 ± 7.60 years) treated with miniscrew-assisted rapid palatal expansion. Buccal bone thickness, dental inclinations and transverse width dimensions (dental, nasal base and jugular) were measured in cone-bean computed tomographies at pre- and post-treatment stages. The variables were compared using the independent t-test. The buccal bone thickness was similar for both groups at the post-treatment stage. The second premolars were significantly more buccal inclined in the AEA group and the right maxillary first molars in the MARPE group. The intercanine and intermolar distances were statistically significantly greater in the MARPE group. Changes in dental arch transverse dimensions were significantly greater for the MARPE group. Both treatment protocols corrected the maxillary transverse discrepancy; however, MARPE provided greater correction.

Facial soft tissue changes and volumetric analysis of upper airways in patients undergoing surgically assisted rapid maxillary expansion using a transpalatal distractor

ObjectiveTo verify changes in facial soft tissue using the RadiANT-DICOM-viewer and Dolphin Imaging software, through linear measurements of tomographic points in a 3D reconstruction of the face and volumetric evaluation with three-dimensional measurements of the upper airways of patients with transverse maxillary discrepancy undergoing Surgically Assisted Rapid Maxillary Expansion (SARME). MethodsRetrospective, transverse, and descriptive study, through the analysis of computed tomography scans of the face of patients with transverse maxillary discrepancy, treated from July 2019 to December 2022. The sample consisted of 15 patients of both sexes, aged 21–42 years old, who underwent surgically assisted rapid maxillary expansion using the transpalatal distractor. Analysis was performed through linear, angular, and three-dimensional measurements in millimeters, in the preoperative and late four-month postoperative period, in frontal 3D tomographic images of the face, in the region of the width of the nose and alar base and also angular measurement in the lateral tomography for the angle nasolabial and upper airways of rhinopharynx, oropharynx and hypopharynx. ResultsThere was an increase in nasal width with an average of 1.3467mm and an increase in the alar base with an average of 1.7333mm. A significant difference was found in the pre- and postoperative assessments of the measurements of nasal width, alar base and nasolabial angle, as well as the upper airways in all their extension. The results favour a better understanding of the professional and the patient regarding the diagnosis and management of patients with transverse maxillary width discrepancies. ConclusionAlthough our study shows an increase in soft tissues after SARME, no aesthetic changes are observed clinically, and all patients report significant respiratory improvement. SARME may therefore contribute to the improvement of professionals working in the field of oral and maxillofacial surgery and orthodontics. Level of evidenceLevel 4.

Prevalence of Malocclusions in Down Syndrome Population: A Cross-Sectional Study.

Background and Objectives: A higher prevalence of dental malocclusion has been suggested among individuals with Down Syndrome (DS) compared to controls, although no studies to date have investigated such a difference according to age group. Therefore, the aim of this study was to compare the prevalence of dental malocclusion and other orthodontic measures between DS and non-syndromic (non-DS) individuals across three age groups of children, adolescents, and adults. Materials and Methods: This cross-sectional study was conducted on a total of 147 patients. Of those, 72 were diagnosed with DS and were divided into N = 15 children (<10 years), N = 23 adolescents (10-18 years) and N = 34 adults (>18 years). The remaining 75 patients were sex- and age-matched controls. The two groups were compared according to age group in terms of the prevalence of dental malocclusion, measures of sagittal, vertical, and transverse discrepancy, facial profile, and probable sleep bruxism with chi-square tests for proportion. Results: The DS patients consistently exhibited a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to the non-DS patients, regardless of age group. The non-DS adolescents presented with a significantly higher prevalence of convex profile than the DS adolescents. The adolescent and adult DS patients most commonly presented with a maxillary transverse discrepancy and posterior crossbite compared to the non-DS controls. The DS adults had a higher prevalence of probable sleep bruxism. Conclusions: Patients with DS showed a higher prevalence of Class 3 malocclusion, concave profile and anterior crossbite compared to non-DS controls, regardless of age group. Other orthodontic measures showed a fluctuation according to the age group considered.

Stability of maxillary expansion osteotomy using patient-specific fixation implants without necessitating removable appliances: a retrospective analysis.

This study aimed to evaluate the long-term stability of surgical maxillary expansion using patient-specific fixation implants (PSFIs) without intraoral retention. Fifteen patients who had undergone segmented Le FortI osteotomy and PSFIs with available preoperative (t0) early (t1) and 1-year follow-up computed tomography (CT) scans (t2) were evaluated. The early and 1-year 3D models were superimposed to transfer the bony landmarks; the distances between each pair of landmarks at the different time points were then measured. The distances between the canines and second molars were also measured directly on the CTscans. The achieved maxillary expansions ranged from a median of 4.39 (2.00-6.27) mm at the greater palatine foramina to a median of 2.14 (1.56-2 > 83) mm at the canine level of the palatal bone. One year postoperatively, the changes in skeletal diameters ranged from a median of - 0.53 (- 1.65 to 0.41) mm at the greater palatine foramina (p = 0.12) to 0.17 (- 0.09 to 0.32) mm at the canine level of the palatal bone (p = 0.56). Changes in dental arch diameters ranged from a median of - 0.6 (- 2 to 0.00) mm between the second molars to - 1.3 (- 1.8 to - 0.25) mm between the canines (P < 0.05). This study showed the stability of maxillary expansion osteotomy using PSFIs, even without postoperative intraoral retention. PSFIs are a reliable method for the surgical treatment of transverse maxillary discrepancy. PFSIs are easy-to-use and improve surgical accuracy.

Immediate dentoskeletal and periodontal effects of miniscrew-assisted rapid palatal expansion: Comparison between young vs middle-aged adults

This study aimed to compare the dentoskeletal and periodontal changes after miniscrew-assisted rapid palatal expansion (MARPE) in patients aged 18-29 and 30-45 years. The sample comprised 28 subjects with transverse maxillary discrepancy successfully treated with MARPE. The young adult (YA) group comprised 14 subjects (mean age, 22.8 years; 3 male, 11 female). The middle adult (MA) group comprised 14 subjects (mean age, 36.8 years; 6 male, 8 female). All patients were treated with a 4-miniscrew MARPE expander. The activation protocol was one quarter turn twice a day until the midline diastema opening, followed by one quarter turn a day until overcorrection. Cone-beam computed tomography (CBCT) scans taken before and immediately after the expansion was analyzed using OnDemand3D Dental software. Using CBCT coronal images, transversal dentoskeletal and periodontal variables were measured in the preexpansion and postexpansion. Intergroup comparisons of expansion changes were performed using t and Mann-Whitney tests (P<0.05). Groups were compatible at preexpansion for most CBCT measurements. A success rate of midpalatal suture opening of 100% and 81% was observed for YA and MA groups, respectively. No intergroup differences were found for the maxillary and dental arch widths increases. The buccal tip of anchorage teeth was observed similarly in both groups. The buccal bone thickness of posterior teeth decreased, and the palatal bone thickness increased after expansion with no difference between groups. After MARPE, the MA group showed similar dentoskeletal and periodontal changes compared to the YA group.

Maxillary Expansion and Its Effects on Circummaxillary Structures: A Review.

Transverse maxillary discrepancies are the most common. The narrowed upper arch is the most prevalent problem an orthodontist encounter while treating adolescent and adult patients.Maxillary expansion is a technique used to increase the upper arch's transverse dimension to apply forces to widen the upper arch. For young children, a narrow maxillary arch has to be corrected using orthopedic and orthodontic treatments. In an orthodontic treatment plan, it is crucial to update transverse maxillary defeat. There are various clinical manifestations associated with a transverse maxillary deficiency which include a narrow palate, crossbite mainly seen in posteriors (unilateral or bilateral), severe crowding in anterior teeth, and cone-shaped hypertrophy can be seen. Some frequently used therapies for constricted upper arch include slow maxillary expansion, rapid maxillary expansion, and surgically assisted rapid maxillary expansion. Slow maxillary expansion requires light and constant force, whereas rapid maxillary expansion needs heavy pressure for activation. The surgical-assisted rapid maxillary expansion has gradually become popular to correct transverse maxillary hypoplasia. The maxillary expansion has various consequences on the nasomaxillary complex. There are multiple effects of maxillary expansion on the nasomaxillary complex. Mainly, the effect is seen on the mid-palatine suture along with the palate, maxilla, mandible, temporomandibular joint, soft tissue, and anterior and posterior upper teeth. It also affects functions like speech and hearing. Information on maxillary expansion is provided in depth in the following review article, along with its various effects on the surrounding structure.

Three-dimensional dentoskeletal changes following minimally invasive surgically assisted rapid palatal expansion: a prospective study

Dentoskeletal changes in minimally invasive surgically assisted rapid palatal expansion (SARPE) were evaluated using cone beam computed tomography (CBCT). This was a prospective study of 30 patients who underwent minimally invasive SARPE performed under local anaesthesia plus sedation by the same surgeon, in an ambulatory setting. Pre- and postoperative CBCT images were obtained for each patient. A statistically significant increase in the linear transverse dimensions of the maxilla occurred systematically. In the canine region, a mean increase of 5.84 mm occurred at the apex level and 7.82 mm at the crown level. These dimensions were 4.83 mm and 7.68 mm, respectively, in the molar region. The cross-sectional area of the maxilla increased by a mean 12.9 mm2 at the palate level and 23.3 mm2 at the crown level. Dental inclination to the buccal aspect was detected (mean 6.1° at the canines and 8.4° at the first molars). The alveolar process tipped buccally 10° at the molar level. Nasal width increased a mean of 3.0 mm at the canine level. Through a three-dimensional analysis, this study found that minimally invasive SARPE was effective in the correction of transverse maxillary discrepancies> 5 mm in non-growing patients. Although dental inclination to the buccal aspect occurred, significant expansion of the maxilla at the skeletal and dentoalveolar levels was confirmed.

Three-dimensional comparison of bone-borne and tooth-bone-borne maxillary expansion in young adults with maxillary skeletal deficiency.

To compare the transverse dental and skeletal changes in patients treated with bone-anchored palatal expander (bone-borne, BB) compared to patients treated with tooth and bone-anchored palatal expanders (tooth-bone-borne, TBB) using cone-beam computer tomography (CBCT) and 3D image analysis. The sample comprised 30 patients with transverse maxillary discrepancy treated with two different types of appliances: bone-borne (Group BB) and tooth-bone-borne (Group TBB) expanders. CBCT scans were acquired before (T1) and after completion of maxillary expansion (T2); the interval was 5.4 ± 3.4 and 6.2 ± 2.1months between the T1 and the T2 scans of Group TBB (tooth-bone-borne) and Group BB (bone-borne), respectively. Transverse, anteroposterior and vertical linear and angular three-dimensional dentoskeletal changes were assessed after cranial base superimposition. Both groups displayed marked transverse skeletal expansion with a greater ratio of skeletal to dental changes. Greater changes at the nasal cavity, zygoma and orbital levels were found in Group BB. A relatively parallel sutural opening in an anterior-posterior direction was observed in Group TBB; however, the Group BB presented a somewhat triangular (V-shaped) opening of the suture that was wider anteriorly. Small downward-forward displacements were observed in both groups. Asymmetric expansion occurred in approximately 50% of the patients in both groups. Greater skeletal vs dental expansion ratio and expansion of the circummaxillary regions were found in Group BB, the group in which a bone-borne expander was used. Both groups presented skeletal and dental changes, with a similar amount of posterior palate expansion. Asymmetric expansion was observed in both groups.

Skeletal and dental changes after microimplant-assisted rapid palatal expansion (MARPE) – a Cephalometric and Cone-Beam Computed Tomography (CBCT) study

ABSTRACT Purpose The maxillary transverse discrepancy is common in orthodontic practice. Rapid palatal expansion has traditionally been used before puberty, but the skeletal effect is limited. Recently, micro-implant-assisted rapid palatal expansion (MARPE) has been proven to be effective in adolescents and adults. The purpose of this study is to assess the skeletal and dental 3-dimensional outcomes after MARPE. Materials and methods Nineteen subjects who presented with a maxillary transverse discrepancy and received MARPE treatment were included in this study. Cephalometric radiographs and Cone-Beam Computed Tomography (CBCT) images were obtained and analysed at the initial (T1) and the end of the expansion (T2). The Wilcoxon signed-rank test was used to evaluate the differences between the two time points. Results The results demonstrated anteroposterior correction. The SNA, ANB, FH-NA, N-A-Pog, A-Na perpendicular (mm) and U1-Nasion perpendicular (mm) all increased from T1 to T2, which explained the maxillary advancement after MARPE. The SN-MP, PP-MP and SNB changes indicated a mandible backward rotation followed expansion. In the CBCT analysis, the average expansion amount was 5.5 mm, of which 71.1% was due to a skeletal effect. In addition, the expansion pattern was almost parallel with a ratio of 83.2% from PNS to ANS. Conclusions MARPE treatment can provide successful transverse correction with near parallel expansion of the maxilla in the coronal and axial planes. Maxillary advancement and a mandibular backward rotation associated with MARPE can provide positive correction in the sagittal plane. As dentoalveolar tipping was limited, the expansion result was mainly skeletal.

Miniscrew-Assisted Rapid Palatal Expansion (MARPE): An Umbrella Review.

In postpubertal patients, maxillary transverse discrepancy is a common condition often requiring surgical approaches. To overcome the excess morbidity and discomfort, maxillary expansion through miniscrew-assisted rapid palatal expansion (MARPE) was proposed and studied in the last few years. This umbrella review aims to critically appraise the quality of evidence and the main clinical outcomes of available systematic reviews (SRs) on MARPE. An extensive search was carried out in five electronic databases (PubMed-Medline, Cochrane Database of SRs, Scielo, Web of Science, and LILACS) until December 2021. The methodological quality was appraised using the A Measurement Tool to Assess SRs criteria 2 (AMSTAR2). The primary outcome was the methodological quality of SRs. Overall, four SRs were included and analyzed, one of high methodological quality, one of low and two of critically low. Despite the verified methodological constraints, MARPE seems to present significant clinical changes when compared to conventional RPE, SARPE or controls and less adverse clinical outcomes. The quality of evidence produced by the available SRs was not favorable. Future high standard SRs and well-designed clinical trials are warranted to better clarify the clinical protocols and outcomes success of MARPE.

Assessment of the bone thickness of the palate on cone-beam computed tomography for placement of miniscrew-assisted rapid palatal expansion appliances

The correction of maxillary transverse discrepancy is achieved by means of rapid maxillary expansion, which may be performed by conventional or surgically-assisted rapid maxillary expansion, and more recently, by miniscrew-assisted rapid palatal expansion (MARPE). This study assessed the bone thickness of the palate on cone-beam computed tomography (CBCT) images for placement of mini-implants and anchorage of MARPE. The sample consisted of 223 CBCT scans from patients of both genders (137 females and 86 males) aged ≥18 years. By using the Image Studio software (Anne Solutions, São Paulo, Brazil), measurements of the bone thickness of the palate were performed bilaterally, as follows: in the axial plane, the bone thicknesses were determined in the anterior region (distal face of the first premolars) and the posterior region (distal face of the first molars), at 3 mm and 6 mm laterally to the midpalatal suture. So in the sagittal plane, the bone thicknesses of the palate were measured in these placements from the palatal cortical to the nasal floor cortical in the anterior region at 30°, 45°, and 90°. In the posterior region, the bone thickness was determined only at 90°. The statistical tests used were the Kruskal-Wallis H test (analysis of variance on ranks) with Dunn's post-hoc test and Mann-Whitney U test (P<0.05). The bone thickness of the palate in the anterior region varied from 8.57 mm in women to 11.28 mm in men at 3 mm from the midpalatal suture and from 7.99 mm in women to 10.47 mm in men at 6 mm for 30°; from 6.35 mm in women to 9.28 mm in men at 3 mm from the midpalatal suture and from 6.20 mm in women to 8.88 mm in men at 6 mm for 45°; from 4.51 mm in women to 6.85 mm in men at 3 mm from the midpalatal suture and from 4.29 mm in women to 6.64 mm in men at 6 mm for 90°. In the posterior region, the bone thickness varied from 2.93 mm (3 mm from the suture) to 1.78 mm (6 mm from the suture) for women and from 3.24 mm (3 mm from the suture) to 1.99 mm (6 mm from the suture) for men. In general, the bone thickness of the palate is greater in the anterior region at 3 mm from the midpalatal suture at 30°. There was high variability in the bone thickness of the palate among patients and in different areas. Therefore, it is necessary to make an individualized diagnosis of the patient and manufacture the MARPE appliance carefully by performing a prior evaluation of the palatal bone thickness by means of CBCT to determine the ideal sites and inclinations for placement of mini-implants.

Testing the Accuracy of Pont's Index in Diagnosing Maxillary Transverse Discrepancy as Compared to the University of Pennsylvania CBCT Analysis.

Introduction: Assessment of maxillary transverse discrepancy requires an accurate tool in order to implement the appropriate treatment plan. Aim: To evaluate the accuracy of Pont’s Index in confirming a transverse maxillary deficiency by comparing its results with the corresponding results yielded by the University of Pennsylvania CBCT analysis. Material and methods: The study was performed on dental casts and CBCT’s of 60 randomly selected patients by adopting a cluster sampling method. The results of Pont’s Index and University of Pennsylvania CBCT analysis were analyzed through McNemar’s test using Excel Data Analysis, and the accuracy indicators for Pont’s Index were computed using MedCalc Ltd. Results: Mc Nemar’s test revealed a p-value of 0.85. The accuracy indicators of Pont’s Index were: sensitivity: 69%; specificity: 16.6%; positive predictive value: 65%; negative predictive value: 18.75%; positive likelihood ratio: 0.83; negative likelihood ratio: 1.86; and accuracy: 53.28%. Conclusion: Due to the fact that CBCT is not used on a daily basis and Pont’s Index has a relatively high sensitivity (69%) making it suitable to detect patients with a narrow maxilla, assessment of the maxillary deficiency on CBCT can be recommended for cases were the midpalatal suture maturation should be evaluated.

Three-dimensional evaluation of skeletal and dental effects of treatment with maxillary skeletal expansion

The objective was to determine the skeletal and dental changes with microimplant assisted rapid palatal expansion (MARPE) appliances in growing (GR) and nongrowing (NG) patients using cone-beam computed tomography and 3-dimensional imaging analysis. The sample consisted of 25 patients with transverse maxillary discrepancy treated with a maxillary skeletal expander, a type of MARPE appliance. Cone-beam computed tomography scans were taken before and after maxillary expansion; the interval was 6.0 ± 4.3 months. The sample was divided into GR and NG groups using cervical vertebral and midpalatal suture maturation. Linear and angular 3-dimensional dentoskeletal changes were assessed after cranial base superimposition. Groups were compared with independent-samples t test (P<0.05). Both groups displayed marked transverse changes with a similar ratio of skeletal to dental transverse changes and parallel sutural opening from the posterior nasal spine-anterior nasal spine; a similar amount of expansion occurred in the anterior and the posterior regions of the maxilla. The maxilla expanded skeletally without rotational displacements in both groups. The small downward-forward displacements were similar in both groups, except that the GR group had a significantly greater vertical displacement of the canines (GR, 1.7 ±1.0 mm; NG, 0.6 ± 0.8 mm; P= 0.02) and anterior nasal spine (GR, 1.1 ± 0.6 mm; NG, 0.5 ± 0.5 mm; P= 0.004). Treatment of patients with MARPE appliance is effective in GR and NG patients. Although greater skeletal and dental changes were observed in GR patients, a similar ratio of skeletal to dental transverse changes was observed in both groups.

Surgically assisted rapid palatal expansion for transverse maxillary discrepancy in adults - Case report.

Introduction and importanceTransverse maxillary deficiency is one of the most detrimental problems to midfacial growth and the integrated dentoalveolar structures. Early diagnosis and proper treatment of such cases is most important to maintain the balance between the basal bones and stable occlusion.Case presentationIn our case, a 17-year-old male had irregular upper front teeth with an unpleasant smile. Detail examination revealed a symmetrical face with an orthognathic profile, mild malar deficiency, competent lips, asymmetrical arches, Class I molar and canine relationships bilaterally. Crowding was present in the upper anterior arch with 2 mm of anterior open bite and posterior cross bite present in the premolar region and molar region bilaterally. Lefort-1 osteotomy, midpalatal split, pterygomandibular disjunction without down fracture was done. The HYRAX appliance was cemented. Distraction started after four days of surgery. One mm distraction per day was done for 10 days. The patient was transferred to fixed orthodontic treatment to relive the anterior crowding. Records were taken after 1 year of follow up and analyzed. Skeletal relationships were in harmony. Dental crowding, anterior open bite and posterior crossbite were corrected.Clinical discussionThe zygomatic buttress and the pterygomaxillary junction are considered as the critical areas of resistance for maxillary expansion. Literature claims lefort-1 osteotomy in combination with palatal distraction results in more displacement and less stress in the maxilla.ConclusionSARPE has proved to be clinically effective and stable for the correction of transversely deficient maxilla after cessation of growth in adult patients.

The Diagnosis Methods and Management Modalities of Maxillary Transverse Discrepancy

Transverse deficiency of the maxilla (TDM) is the most common skeletal change that involves the maxilla. The craniofacial skeletal assessment as early as possible is critical, as the early diagnosis of TDM influences the effectiveness of treatment. Methods for treating TDM have been reported since the mid-19th century and continue to evolve. This article puts forward a literature review on the topic, investigating the diagnosis and management of TDM, as well as stability after surgical and nonsurgical interventions. We conducted a literature search using a logical combination of the terms “palatal extension,” “maxillary transverse deficiency,” “diagnosis,” and “management.” More recent approaches include three-dimensional imaging, which has allowed for accurate depictions of the craniofacial region to be examined, allowing for evaluation of the spatial relationships between the jaw elements. The success of nonsurgical management compared to surgical management depends on the growth stage of the patient. Unfortunately, data comparing the stability of surgical and nonsurgical management is still lacking. However, for surgical intervention, surgically assisted palatal expansion (SARPE) appears to be the appropriate choice, especially when a large expansion is needed.

Evaluation of Patients’ Experiences after Microimplant-Assisted Rapid Palatal Expansion (MARPE) Treatment

Purpose: Various microimplant- assisted rapid palatal expansion (MARPE) appliances were developed in these years. By applying this procedure, maxillary transverse deficiencies can be corrected in adults with limited dental tipping. However, some undesirable effects could happen during treatment. In this study, we aimed to record the incidence of any adverse effect or complication. Pain score was also measured during treatment. Patients and Methods: Twenty-nine patients (22.8 ± 8.6 years old) with 13 males and 16 females were enrolled. Clinical photographs, radiographs and cone-beam computed tomography were taken before insertion of MARPE and after expansion. Interview was conducted by one orthodontist with a questionnaire recording the experiences throughout the MARPE procedure. Results: The mean pain score during activation was 4.38 ± 2.4, moderate in pain category. Inflammation of palatal mucosa was reported by 48.3% of subjects. There were 41.4% of subjects complained difficulty in cleaning and 37.9% experienced soft tissue impingement. Distortion of expander components presented in four subjects, and only one microimplant was loosened during expansion. Two subjects reported tinnitus on and off during MARPE activation. Sutures failed to open on three subjects, and the overall success rate was 89.7% in terms of suture opening. Self-perceived asymmetrical expansion was reported by four subjects. Conclusions: Although some adverse effects and complications were reported in this study, MARPE can still provide good outcomes on correcting maxillary transverse discrepancies in skeletally matured patients. The overall success rate is high with moderate patient’s pain level. Oral hygiene should be emphasized since the inflammation of palatal mucosa is the most frequent complication during treatment. With all the possible adverse effects in mind, clinician may be more confident in providing MARPE treatment.