Premolar Area Research Articles

Immediate versus delayed loading of a new conical connection implant in the esthetic zone: a randomized study with 2-year follow-up

Aim The aim of this study is to compare immediate versus delayed loading protocol of a new conical connection implant in the esthetic zone. Materials and methods Patients requiring single-tooth extraction for root fractures or periodontal disease in the maxillary or mandibular anterior or premolar areas were selected for the present study. After extraction, implants were placed immediately in fresh sockets. After randomization process, in group A immediate loading was performed while in group B a delayed loading protocol was followed. In both groups mean marginal bone loss was measured through intraoral digital radiographs at 3, 6, 12 and 24-month follow-up. Results At 24-month, a survival rate of 100% was reported. For group A a mean marginal bone loss of 0.10 ± 0.09 mm was found, while for group B a value of 0.11 ± 0.08 mm was measured. No statistically significant differences between groups were found at each time point (P>0.05). Conclusion When used in postextraction immediate and delayed loading implant rehabilitation, the new conical connection implant showed a good clinical outcome at 24-month follow-up.

CORRELATION BETWEEN BITING FORCE AND MUSCLE ACTIVITY ACCORDING TO IMPLANT POSITION IN LOWER CLASS I KENNEDY PARTIAL DENTURE

Purpose: The placement of dental implants in a distal RPD extension provided more stable and reliable occlusion. The target of this trial was to investigate the degree of correlation between the maximum biting force and surface electromyography of masseter fibers and anterior fibers of temporalis in two different implant positions in lower Kennedy class I Material and methods : Fourteen patients having lower Kennedy class I with the first premolar as the last abutment and completely dentulous maxilla were randomly divided into two equal groups to receive implant supported partial overdenture. Each group received posterior bilateral two implants in the second molar area in the first group, while the group 2 one in the second premolar area. Right and left Maximum biting force was measured for both groups using I loadstar sensor and masseter and anterior temporalis muscle activity were evaluated with Surface ElectromyographyResult : The data revealed that group I had significant positive correlation between maximum biting force and the masseter and anterior temporalis muscles activity in both the right and the left side with r value (1 , 0.79 , 0.89 and 0.75) respectively on the other hand the group II showed no significant positive correlation with r(0.04,0.01.-0.04 and -0.11) respectivelyConclusion : Within the limitation of this clinical trial, it was concluded that there were better muscle coordination between the two largest muscles of mastication (masseter and temporalis) and the produced biting force as a product due to installation of posterior implant in the lower second molar area.

A NEW DEVICE MEASURES RETENTION CLINICALLY FOR IMPLANT RETAINED OVERDENTURE

This article describe a new device that can be used for clinical measurement of retention for implant retained overdenture. This device overcomes the problems of the used techniques in terms of vertical direction of force. The force will be perpendicular to the patient’s occlusal plane. The method allows also complete standardization between time intervals.The device consists of plate form with vertical arms and middle screw that move vertically to guide the movement of the force meter in vertical direction. A fork is used to connect the force meter to the implant retained prosthesis through four hooks to canine and first premolar areas bilaterally moving it completely vertical.

Effect of Attachment Type on Implant Strain in Maxillary Implant Overdentures: Comparison of Ball, Locator, and Magnet Attachments. Part 1. Overdenture with Palate.

Implant overdentures with attachments have been used in clinical practice and the effect of attachments on implant strain has been frequently reported. However, most studies have focused on mandibular overdentures; there are few reports on maxillary overdentures. The purpose of this study was to examine the influence of attachment type on implant strain in maxillary overdentures under various implant configurations. A maxillary edentulous model with implants and experimental overdentures were fabricated. Four strain gauges were attached to each implant, positioned in anterior, premolar, and molar areas. Three types of unsplinted attachments-ball, locator, and magnet-were set on the implants under various implant configurations. A vertical occlusal load of 98 N was applied through the mandibular complete denture, and implant strain was compared using the Kruskal-Wallis test. Ball attachments caused the greatest amount of strain, while magnet attachments caused the least amount under all conditions. For all attachments, two anterior implants caused significantly more strain than four implants (P < .05). No significant difference was observed between subtypes in four-implant configurations except when using locator attachments. When using unsplinted attachments for maxillary implant overdentures, magnet attachments are recommended to reduce implant stress. Using only two implants, especially two anterior implants, is not recommended regardless of attachment type.

GINGIVAL CYST OF ADULT WITH RADIOGRAFIC FINDINGS: A RARE CASE

Gingival cyst of adult (GCA) is an uncommon developmental cyst of gingiva arising from the rests of dental lamina. GCA occurs characteristically in the mandibular canine and premolar area and it is considered to represent the soft tissue counterpart of the lateral periodontal cyst (LPC). Radiologic changes occur in a small number of GCA. A 59-year-old female patient was referred to the University Hospital because of a firm and sessile nodule measuring 1.2 cm, located on the buccal papillae between the teeth 33–34. Radiographic analysis showed saucerization of the intercrestal bone with trabeculae within. The lesion was treated by surgical excision under local anesthesia. The histopathologic examination revealed a connective tissue capsule lined by thin non-keratinized squamous epithelium with focal nodular thickenings. The clinical diagnosis was established during surgical procedure, a depression in the outer cortical bone was observed in the LPC, the outer cortex is intact or expanded.

Effect of Attachment Type on Denture Strain in Maxillary Implant Overdentures: Part 1. Overdenture with Palate.

This study examined the effects of attachments on strain in maxillary implant overdentures supported by two or four implants. A maxillary edentulous model with implants inserted into anterior, premolar, and molar areas was fabricated, and three types of unsplinted attachments-ball, locator, and magnet-were set on the implants distributed under various conditions. Maxillary experimental dentures were fabricated, and two strain gauges were attached at the anterior midline on the labial and palatal sides. A vertical occlusal load of 98 N was applied and shear strain of the dentures was measured. On both sides, magnet attachments resulted in the lowest shear strain, while ball attachments resulted in the highest shear strain under most conditions. However, differences in shear strain among the three attachment types were not significant when supported by four implants, especially molar implants. Shear strain of the maxillary implant overdenture was lowest when using magnet attachments. Magnet attachments mounted on four implants are recommended to prevent denture complications when using maxillary implant overdentures.

The Role of Cone-Beam Computed Tomography in Diagnostics of Cystic Masses of the Jaw

Research objective. The study aimed to evaluate cone-beam computed tomography (CBCT) capabilities in diagnostics of cystic masses of the jaw.Methods. Over a period of 2015–2016 32 patients age 6 to 67 underwent both panoramic tomography and CBCT (using panoramic tomographic scanner STRATO 2000 and cone-beam computed tomographic scanner i-Cat respectively). 47% (n = 15) of the participants were women, 53% (n = 17) – men. Radiation exposure for a single procedure amounts to 0,05 mSv for panoramic tomography, 0,07 mSv for CBCT (FOV =13 cm), 0,06 mSv for CBCT (FOV =8 cm).Results. Comparative analysis of obtained results demonstrates that CBCT showed 54% (n = 27) more cystic masses of the jaws than panoramic radiography could. CBCT additionally showed the following pathologies: granulomas smaller than4 mm diameter – 85% (n = 23), 83% (n = 23) of said granulomas were found on maxilla, radicular cysts of maxilla – 11% (n = 3), incisive canal cyst – 4% (n = 1). Additionally panoramic tomography analysis misdiagnosed 5 granulomas (80% (n = 4) on mandibular premolar and molar areas) that were not found during CBCT analysis.Conclusion. The low effective dose and high informativity of CBCT enables the method to be used instead of intraoral radiography, panoramic tomography and MSCT as a screening procedure in diagnostics of dento-facial system pathologies, including cystic masses of the jaw.

The application of a delayed expansion technique for horizontal alveolar ridge augmentation in dental implantation

The aim of this study was to evaluate the application of delayed expansion of the alveolar ridge in dental implantation. This method avoids the need to harvest autogenous bone and the requirement to fix a block with screws, and could help prevent the uncontrolled fracture and avascular necrosis that may result from the traditional alveolar split. Eighteen patients and 43 implants were included in this retrospective study. The width of the alveolar ridge was measured before implantation, immediately after implantation, and after the final restoration. The width increased significantly after the insertion of implants and decreased slightly after bone remodelling. Overall, the width of the alveolar ridge increased by 2.37±1.44mm on average, ranging from −0.20mm to 5.75mm. The results suggest the use of delayed expansion for horizontal alveolar bone augmentation; however, the maxillary premolar area may not be a suitable site.

Effect of different restorative crown and customized abutment materials on stress distribution in single implants and peripheral bone: A three-dimensional finite element analysis study

Statement of problemIn recent years, the use of resin-matrix ceramics and polyetheretherketone (PEEK) abutments has been suggested to absorb excessive stresses on dental implants. However, only a few studies have evaluated the effect of these materials on stress distribution in implants and peripheral bone structure. PurposeThe purpose of this finite element analysis was to evaluate the biomechanical behaviors of resin-matrix ceramics and PEEK customized abutments in terms of stress distribution in implants and peripheral bone. Material and methodsThree-dimensional (3D) models of a bone-level implant system and a titanium base abutment were created by using the standard tessellation language (STL) data of original implant components. An anatomic customized abutment and a maxillary right second premolar crown were then modeled over the titanium base abutment. A bone block representing the maxillary right premolar area was created, and the implant was placed in the bone block with 100% osseointegration. Six different models were created according to combinations of restoration materials (translucent zirconia [TZI], lithium disilicate glass ceramic [IPS], polymer-infiltrated hybrid ceramic [VTE]), and customized abutment materials (PEEK and zirconia). In each model, the implants were loaded vertically (200 N) and obliquely (100 N). The stress distribution in the crown, implant, and abutments was evaluated through the von Mises stress analysis, and the stress distribution in the peripheral bone was examined through the maximum and minimum principal stress analyses. ResultsThe oblique load resulted in high stress values in the implant components, restorative crown, and cortical bone. Low stress values were observed in the VTE crowns. Zirconia customized abutments exhibited higher stress values than PEEK customized abutments. The stress distributions in the implant and peripheral bone were similar in all models. ConclusionsChanges in restoration and customized abutment material did not affect stress distribution in the implant and peripheral bone.

Experimental evaluation of stress distribution with narrow diameter implants: A finite element analysis

Statement of problemNarrow diameter implants were developed to allow placement in narrow alveolar ridges. Clinicians may have concerns about the durability and function of such implants. PurposeThe purpose of this finite element study was to compare the stress values occurring on the implant and at the implant bone interface after the application of the static and dynamic forces on narrow diameter, titanium and titanium-zirconia implants in the maxillary and mandibular second premolar region. Material and methodsTitanium (Ti) and titanium-zirconium (Ti-Zr) narrow diameter implants (3.3 mm in diameter, 10 mm in length) were simulated in the maxillary and mandibular second premolar region, and metal-ceramic crown restorations were designed. Forces of 100 N were applied to crowns in a vertical and oblique (45-degree angle to the long axis) direction. Maximum and minimum principal stresses in the cortical and trabecular bone and the von Mises stresses and fatigue strength of the implants were evaluated with 3-dimensional finite element analysis. ResultsIn vertical and oblique static loading, Ti and Ti-Zr implants showed similar stress distribution within the same jaw models. However, the von Mises stresses in Ti-Zr implants were slightly higher than for Ti implants in all models. In oblique static and dynamic loading, all stresses were found higher than vertical loading, and fatigue failure results were found to be more critical than vertical forces. ConclusionsBased on a numerical simulation, Ti and Ti-Zr alloys can be used successfully as narrow diameter implants in the second premolar area.

Prevalence of idiopathic osteosclerosis on cone beam computed tomography images

Objectives This study was performed to investigate the prevalence of idiopathic osteosclerosis on cone beam computed tomography (CBCT) images of patients.Methods In this descriptive, cross-sectional study, 240 CBCT scans of patients (125 women, 115 men) referred to a private oral and maxillofacial radiology clinic in Tehran in 2013 were selected and evaluated. Presence of idiopathic osteosclerosis and its features including its location in the jaw, its association with teeth, presence or absence of root resorption, number, shape and size of lesions and age and gender of patients were assessed. Descriptive statistics were reported. Chi-square test and independent t-test were used for statistical analysis.Results Idiopathic osteosclerosis was seen on CBCT images of 20 patients (8.33%). The lesion was more frequent in women than men, but the difference was not significant (P = 0.50). Also, the lesion was more common in the mandible than the maxilla (95.6% vs. 4.4%). Most lesions were observed in the molar (56.5%) and premolar (34.7%) areas of the lower jaw. Most lesions did not have any association with teeth (73.9%). More than half of the lesions (56.5%) were round in shape and the rest (43.4%) were irregular. The mean size of the lesions was 5.4 ± 1.8 and 5.7 ± 1.4 mm in the mesiodistal and superior-inferior aspects, respectively.Conclusion The prevalence of idiopathic osteosclerosis of the jaws on CBCT images of an Iranian population was within the range reported by other studies. The lesions were more common in the mandibular molar region with no relation to teeth.

Sinus Membrane Elevation by the Crestal Approach Using a Novel Drilling System.

The purpose of this study was to evaluate the clinical outcomes of patients undergoing sinus membrane elevation by a minimally invasive crestal approach using a novel drilling system. From May 2008 to November 2009, 21 implants were placed in 19 patients (10 men and 9 women) ranging from 23 to 69 years of age (average of 49.5 years). Implants were placed in maxillary premolar and molar areas that demonstrated insufficient residual bone quality; maxillary sinus membrane elevation was performed using a crestal approach with the sinus crestal approach kit (Neobiotech, Seoul, Korea). There was no sinus perforation or osseointegration failure. The implant survival rate was 100%. The postsurgical, augmented volume of the alveolar height ranged from 2 to 9.2 mm (average of 5.81 ± 2.06 mm). Six months after maxillary sinus elevation, the bone reduction volume ranged from 0.06 to 1.42 mm (average of 0.6 ± 0.38 mm). At final F/U, the amount of bone-height reduction ranged from 0.06 to 2.60 mm (average of 0.82 ± 0.63 mm). Sinus membrane elevation by the crestal approach using special reamers is advantageous because of the noticeable reduction in the risk of perforation and the ability to perform the surgery rapidly.

What Are the Incidence and Factors Associated With Implant Fracture?

Implant fracture is a serious complication, which leads to treatment failure. The purpose of this study is to estimate the incidence of implant fractures and identify factors associated with them. In this retrospective cohort study, the sample was derived from 2 implant centers. The predictors were grouped into the following categories: demographic, location of implant, physical characteristic of implant, implant-abutment connection, type of prosthesis, type of retention, and outcome variable (time to implant fracture). The Kaplan-Meier test was used to estimate implant survival. A Cox regression model was applied to evaluate the time-to-event effect of variables on implant fracture. Of 18,700 implants, 37 (0.002%) had fractures. The 1- and 5-year risk of implant fracture was 0.38 per 1,000 and 1.46 per 1,000, respectively. Implant fractures more often occurred in the premolar and molar area (94.6%) than in the anterior of the jaws. The Pearson correlation test did not show any correlation between age, implant diameter, or implant length and time of fracture (P>.05). Analysis of the data by the log-rank test showed a significant difference for survival between cemented and screw-retained crowns (P=.001). The Cox regression model showed a hazard ratio of 0.23 for tapered implants versus cylindrical fixtures and for screw-retained crowns (hazard ratio, 296.54) versus cemented crowns. According to this study, conical implants and screw-retained prostheses may have lower survival rates due to implant fracture.

Evaluation of mandibular inferior cortex changes in patients candidate for liver and kidney transplantation using panoramic view

Background: The number of patients with chronic liver failure (CLF) or chronic kidney disease (CKD) referred to dental clinics are increasing. However, there are few studies about the effect of these diseases on jaw bones. Objectives: The aim of this study was to evaluate the inferior mandibular cortex changes of the patients with CLF and CKD that are candidate for liver and kidney transplantation, in panoramic views. Patients and Methods: Panoramic radiographs were obtained from 83 patients with a history of CLF and 43 patients with CKD who were undergoing the assessment for transplantation and also 126 control cases. The mean was calculated for the width of inferior mandibular cortex. The relationship between the thicknesses of the inferior mandibular cortex with the duration of disease was determined using Pearson’s correlation coefficient test. T and chisquare tests were used for evaluating the inferior cortex of the mandible according to age and sex, respectively. Results: Compared with the control group, the means of the cortical thickness in CLF and CRF patients were significantly different (P < 0.001). There was a significant relationship between cortical thickness and gender in CLF (P = 0.007) and CRF patients (P = 0.029). Neither the duration of the disease and nor age was associated with mandibular thickness changes in CLF and CRF patients (P = 0.79). Thickness of the inferior mandibular cortex in premolar area was more than that in molar area and thickness of molar was greater than that of the mandibular angle in CKD and CLF patients. This latter was similar to that in normal subjects. Conclusion: Compared with normal population, a decrease in the thickness of inferior mandibular cortex is observed in CKD and CLF patients. This decrease is not affected by age and duration of the disease but is meaningfully related to sex, especially females.

PATTERN OF POSTERIOR RESIDUAL RIDGE RESORPTION UNDER MANDIBULAR IMPLANT HINGING OVERDENTURES: A 5 –YEAR RETROSPECTIVE STUDY

Purpose: This 5-year retrospective study aimed to investigate and compare the effect of bar designs of two-implant-retained overdentures (2-IRO) on pattern of the residual ridge resorption (RRR) of the posterior mandibles using 3-D Cone Beam Computed Tomography (CBCT) imaging. Materials and Methods: Forty five edentulous patients treated with mandibular 2-IRO opposing maxillary complete denture were selected for the study. According to bar designs; the enrolled patients were divided into three groups: Group BC (n=19) patients treated with two-implant overdentures retained by a bar joint with a plastic retentive clip. Group BL (n=14) patients treated with two-implant overdentures retained by locator attachments on the top of milled bar. Group BD (n=12) patients treated with two-implant overdentures retained by a straight bar with a plastic retentive clip & distally cantilevered ball attachments. The pattern of posterior RRR was evaluated by using CBCT imaging after 5 years post-treatment. Results: The overall vertical means of RRR differences were highly significant between three bar groups (BC, BD, and BL) using One Way ANOVA test with LSD post hoc. For group BL, no significant differences were revealed in height and width (for both buccal and lingual sides) of alveolar bone when comparing molar and premolar areas. For group BD, the reduction in RRR recorded highly significant differences (p<0.001) in height and width (for lingual side only) with statistical significant increase at molar than premolar areas.Conclusion: Taking the limitation of this study into considerations; Mandibular posterior residual ridge resorption occurs irrespective of 2-IRO design. The impact of bar design on the rate of residual ridge resorption is a matter of controversy. Unless limited by the available restorative space; milled bar design with locator retainer could be considered the bar design of choice regarding the rate and pattern of RRR.

Clinical evaluation of the effects of free gingival and extracellular matrix grafts to increase the width of the keratinized tissue around dental implants

Inadequate keratinized mucosa around dental implants can lead to more plaque accumulation, tissue inflammation, marginal recession and attachment loss. We evaluated the effects of free gingival and extracellular matrix membrane grafts performed to increase the insufficient width of keratinized tissue around dental implants in the posterior mandible. A 47-year-old female patient presented with discomfort due to swelling of the lower right second premolar area. Due to severe destruction of alveolar bone, the tooth was extracted. After 3 months, a guided bone regeneration (GBR) procedure was performed and then a dental implant was placed 6 months later. During the second-stage implant surgery, free gingival grafting was performed to increase the width of the keratinized tissue. After 12 months, a clinical evaluation was performed. A 64-year-old female patient had a missing tooth area of bilateral lower molar region with narrow zone of keratinized gingiva and horizontal alveolar bone loss. Simultaneous implant placement and GBR were performed. Five months after the first-stage implant surgery, a gingival augmentation procedure was performed with an extracellular matrix membrane graft to improve the width of the keratinized tissue in the second-stage implant surgery. After 12 months, a clinical evaluation was performed. In these two clinical cases, 12 months of follow-up, revealed that the increased width of the keratinized tissue and the deepened oral vestibule was well maintained. A patient showed a good oral hygiene status. In conclusion, increased width of keratinized tissue around dental implants could improve oral hygiene and could have positive effects on the long-term stability and survival rate of dental implants. When planning a keratinized tissue augmentation procedure, clinicians should consider patient-reported outcomes.

Three-dimensional evaluation of the location of the mandibular canal using cone-beam computed tomography for orthodontic anchorage devices.

This study investigated guidelines for placement of monocortical screws in the mandible, particularly the mandibular canal. In this study of 35 patients, we used cone-beam computed tomography to determine the distance from the alveolar crest to the superior border of the mandibular canal (DMC) and the shortest distance from the buccal and lingual cortex to the mandibular canal (attaining distance) in the areas between premolars (premolar area), between the second premolar and first molar (middle area), and between the first and second molars (molar area). The DMC values for these areas were 16.55, 18.94, and 16.58 mm, respectively, and were similar in adults and adolescents. When the attaining distance was 8 mm, the heights on the buccal and lingual sides of the areas were 9 and 16.6 mm, 13.7 and 14.7 mm, and 15.3 and 12 mm, respectively. Risk of proximity to the mandibular canal should be considered at above heights or greater when an orthodontic anchorage device (OAD) 8 mm in length is placed. Careful attention is needed for placements on lingual side in adolescents. By reducing the OAD length to 6 mm, placement safety increases in all areas except the premolar area, especially on the buccal side.

Three-point bending test simulation on implant fpds with a bio-faithful model.

It is well known by previous important studies that mandible flexes during different jaw movements. According to this assumption it is very important to know how implant supported fixed partial dentures could restrict mandibular movements and, could lead to excess strain accumulation that could modify the resolution of implant treatment. The aim of our project is to create a bio-faithful model able to recreate mandibular movements, during three point bending test methods of (FIXED -PARTIAL -DENTURES) FPDs, to avoid a not flexible metal base, where models' properties doesn't allow to obtain a bio-faithful simulation during testing phases. 2 implants (premium Sweden and Martina®) were embedded in mandible resin section to mimic osteointegrated implants in premolar and molar areas, in order to recreate a Kennedy Class II configuration. Our mandible test simulator was creating according to the measurement obtained according to the study of Schwartz-Dabney and Dechow (2002). Sample so created is tested with testing machine (Instron 5566®, UK) adopting the three point bending mechanical tests configuration. We can admit that oral cavity is a bio-dynamic system, where different variables incurr, so it's very important that experimental conditions simulate clinical environment. Experimentation should be based on the correlation between the failure mechanisms exhibited for in vitro samples and those observed in fractured clinical prostheses made of the same composition and processing conditions. A bio-faithful model could reduce this wide range between in vitro and in vivo study experimentation.

ASSESSMENT OF SOFT TISSUE EXPANSION USING OSMED SELF INFLATING HYDROGEL PRIOR TO MANDIBULAR RIDGE AUGMENTATION

Objectives: This study was conducted to assess the ability of self-inflating tissue expander to produce proper amount and quality of mucosa prior to bone grafting and implants insertion and degree of bone graft survival in severely atrophied alveolar ridges. Material and Methods: All patients included in this study were referred to the Department of Oral and Maxillofacial Surgery, Faculty of Oral & dental Medicine, Cairo University for rehabilitation with dental implants. Inclusion criteria comprised: Missing mandibular premolar or molar area with a buccal osseous and soft tissue defect. The adjacent teeth had to be uncompromised with healthy gingival conditions. The exclusion criteria were patients who did not need bone grafting before implant placement. There were 10 patients (6 men and 4 women), with a mean age of 32 years (range, 18-60 years), who fulfilled the inclusion criteria and were consecutively included in the study. All patients were healthy and had no systemic contraindications to implant placement. They received standard treatment planning and diagnosis and gave signed informed consent. All 10 patients had an osmotic soft tissue expander implanted in the area with osseous and soft tissue defect, prior to bone grafting using bovine bone graft. Linear and volumetric measurements of the bone grafts were recorded immediately following bone graft and 6 months post grafting using cone beam CT scans.Results: 10 sites in 10 patients were treated with soft tissue expansion using self inflating hydrogels. Complications of soft tissue expansion were only perforation (two sites), and no infection was noted. Primary wound closure was easily attained during bone augmentation procedure with no incidence of graft exposure, infection, or loss. It also allowed for good vertical bone height gain for implant placement. Volumetric measurements showed that an average mean of 1.36 cm3 mandibular ridge augmentation was established immediately Post bone grafting and 1.19 cm3 6 months after bone grafting. These measurements concluded that only 15.7% bone resorption occurred 6 months after bone grafting indicating good survival of the xenogenic bone graft.Conclusion: The use of Osmed self-inflating tissue expander prior to bone augmentation and implants insertion allowed sufficient amount of mucosa that can cover the grafts and implants without tension or compromise to the periosteum and ensued minimal bone graft resorption in severely atrophied alveolar ridges.

Wing-bib multi helix maxillary expander

An orthodontic appliance for maxillary expansion is presented, which consists of a wire assembly fabricated from 0.032” round straight length beta-titanium wire. Posterior active portion of the appliance consists of a trihelix omega loop parallel to palatal surface, providing transverse expansion and distalizing forces on the first molars. Anterior active portion consisting of an acrylic apron (bib) over a (wing-like) wire framework, provides transverse expansion at the anterolateral slopes of the palate including the depths; lying directly over the envisioned canine- first premolar root area of the palatal vault surface.