Palatal Expansion Research Articles

Interceptive and orthodontic treatment provided by pediatric dentists in Jordan

Objectives: The purposes of this study were to document the interceptive and orthodontic treatment currently provided by pediatric dentists in Jordan, to determine the type(s) of treatment and appliances provided, and to ascertain variables that would influence practitioners’ treatment patterns.
 Methods: A cross-sectional survey carried out among pediatric dentists. A structured questionnaire was used, distributed directly by hand to individual pediatric dentist at place of practice, and collected after one week. Descriptive analysis and Chi-square test were used. The level of significance was set as 0.05.
 Results: The majority of pediatric dentists (89%) provided orthodontic treatment. Pediatric dentists have unlikely expectations concerning the benefits of orthodontic treatment. The most frequently provided treatments were for space maintenance (99%), and oral habits conditions (94%). The most utilized appliances were space maintaining appliances (99%), habit breaker appliances (83%), upper removable orthodontic appliances (with finger or Z spring and anterior expansion screw) (66%), and palatal expansion appliances (53%). Variables that would significantly affect the type of treatment and appliances used were place of practice, annual hours spent in continuing education in orthodontics, confidence level in providing treatment, and nearest orthodontist’s location.
 Conclusions: Most of the pediatric dentists provide orthodontic treatment with high expectations concerning the benefits of providing it. This study documents the interceptive and orthodontic treatment currently provided by pediatric dentists in Jordan. It summarizes treatment and appliances provided, and variables that would influence practitioners’ treatment patterns.

Difference in Using Protrusion Face Mask before or after Rapid Palatal Expansion in Skeletal Class III Children: A Preliminary Study.

: IntroductionTreatment of third-class malocclusions often presents a challenge for orthodontists. Skeletal disharmony is often associated with dental malposition. There are several therapeutic choices, including the use in combination of transverse expansion of the maxilla with rapid palatal expander (RPE) and posterior-anterior traction with a Delaire face mask (FM). The purpose of the study is to verify whether there are significant differences in the treatment outcome in the case of use of a face mask followed by a palatal expander or with the sequence of these auxiliaries reversed. Subject and Methods: The two groups were both made up of 13 patients, subdivided into group A, i.e., those whose sequence involved the use of extraoral traction first and then the disjunctor, and those with an inverted sequence in group B. Some cephalometric parameters and dento-skeletal characteristics were evaluated pre-treatment (t0) and at the end of therapy (t1). Results: Considering the T1–T0 of group A (Delaire + rapid palatal expander), the evaluation of the results obtained in this work allows us to observe how within group A there is a significant improvement in the Witts and Nanda indices and facial convexity. Group B (treated with the palate disjunctor sequence followed by traction with Delaire’s mask) showed a significant improvement in ANB, in AoBo, and AppBpp values and in convexity. The two groups were comparable, and no statistically significant difference was highlighted. Discussion: The early therapy of the third skeletal classes by means of a rapid palate expander and face mask is effective. There is no statistically significant difference in the two groups who performed the therapy in reverse mode. This suggests that the clinician should choose the treatment sequence based on the skeletal and occlusal conditions of their patients at the start of treatment. Conclusion: Early therapy of third skeletal classes with sagittal expansion using a rapid palate expander can be performed earlier or later than posterior-anterior traction with a Delaire mask.

Age-dependent interactions of maxillary sutures during RME and their effects on palatal morphology : CBCT and dental cast analysis.

PurposeThe effects of rapid maxillary expansion (RME) on the transverse palatine and midfacial sutures have been extensively scrutinized. Unlike the dentition stage, age-dependency was not yet regarded when investigating morphological changes of the tooth-bearing palate. Therefore, the first aim of the present study was to analyse age-dependent sutural and morphological changes of the palate in selected patients by cone-beam computed tomography (CBCT) and dental cast analysis. Secondly, age-dependent effects of RME on width, height, and depth of the palate in the region of the maxillary palatine processes were investigated by a comprehensive dental cast study, so that the combination of results could be used to provide a biomechanical explanation of the occurring changes.MethodsCBCT datasets of 9 patients (between 7.3 and 13.8 years) were measured around the median palatal suture and compared with the results of an individualised dental cast analysis. In addition, possible effects on other maxillary sutures were investigated. In the dental cast study, changes after RME in the tooth-bearing palate were analysed three-dimensionally in 60 children and adolescents. It was possible to divide those into three equally sized, age-dependant groups (PG1: < 10 years, n = 20; PG2: ≥ 10 < 12 years, n = 20; PG3: ≥ 12 years, n = 20).ResultsThe CBCT analysis reveals age-related differences in sutural responses. The opening width of the median palatine suture decreases cranially (frontal) and dorsally (horizontal). The opening mode thus changes from parallel to triangular in both planes. The transverse palatine suture completely opens in younger patients only (PG1 and PG2). The width increases are always significant in all patients. While in PG1 the width increase is greater posteriorly than anteriorly, this is always reversed in PG2 and PG3. The palatal height always increases significantly anteriorly, but posteriorly only in the youngest patients (PG 1) median and paramedian. In PG 2 and PG 3, the posterior height change is very small. That is the reason why the anteroposterior comparison reveals a much more pronounced height increase anteriorly than posteriorly.ConclusionThe comparison of selected CBCT data with a dental cast analysis allows the conclusion that the maxillary expansion after RME in children up to 10 years is rather parallel, whereas it occurs V‑shaped (anterior > posterior transversal, inferior > superior vertical) with increasing age, especially in adolescents from the age of 12. In addition to an age-progressive rigidity of the pterygopalatomaxillary junction, morphological changes of the transverse palatine suture during growth seem to be causal. Thus, age-dependent effects of palatal expansion occur due to a positional change of maxillary centres of rotation and resistance. From dental cast measurements, especially at the skeletal–basal level, conclusions can be drawn about the median palatal suture opening mode.

Pediatric maxillary expansion has a positive impact on hearing? A systematic review and meta-analysis

ObjectiveHearing loss is a highly prevalent condition in the pediatric population. Pediatric maxillary expansion is a widespread treatment to address transverse maxillary deficiency. First reports describing an association between improvements for patients with HL and PME initiated in the 1960s. In this systematic review and meta-analysis we aim to review the role of maxillary expansion in reducing conductive hearing loss in pediatric population. Review methodsPubmed (Medline), the Cochrane Library, EMBASE and Trip Database were checked. Main outcome was expressed as the difference between air-bone gap, compliance, ear volume and conductive hearing thresholds before and after treatment and the 95% confidence interval. ResultsA total of 10 studies (218 patients) met inclusion criteria. The pooled data in the meta-analysis under a random effects model shows a statistically significant difference of 10.57dB mean reduction after palatal expansion. The air-bone gap was significantly reduced by 5.39dB (CI 95% 3.68, 7.10). Compliance and volume were assessed in three studies, with a non-significant positive difference in the compliance (0.14) and a statistically significant difference for volume (0.80) after palatal expansion. ConclusionThis systematic review and meta-analysis found a positive effect of pediatric maxillary expansion in conductive hearing loss in well-select children. However, results cannot be extrapolated for children with conductive hearing loss without an accompanying orthodontic indication (maxillary constriction). It showed that the existing prospective studies exhibited qualitative pitfalls, limiting the ability to obtain conclusive evidence about the role of pediatric maxillary expansion on conductive hearing loss in children.

Single-incision mini-invasive surgery for miniscrew-assisted rapid palatal expansion

Single-incision mini-invasive surgery for miniscrew-assisted rapid palatal expansion

Soft tissue evaluation after maxillary protraction with RPE or with the ALT-RAMEC protocol : Acontrolled 3D study.

To evaluate soft tissue changes following maxillary protraction with different expansion protocols using three-dimensional (3D) stereophotogrammetry. Pretreatment (T0) and postprotraction (T1) stereophotogrammetry and lateral cephalometric images of skeletal classIII patients were included in this retrospective study. In all, 32patients were treated either with acombination of rapid palatal expansion and facemask (RPE/FM; n = 16; mean age: 9.94 ± 0.68years) or with alternate rapid maxillary expansion and constriction together with afacemask (Alt-RAMEC/FM; n = 16; mean age: 9.74 ± 1.35years). As acontrol group16 untreated patients were recruited (mean age: 9.46 ± 0.8years). For superimpositioning of the 3D images taken at T0 and T1, the face was divided into defined regions and 3D and differences between the groups were evaluated using 3‑matic software (Materialise Europe, Leuven, Belgium). Cephalometric analyses were also performed. While the increases in the cephalometric parameters SNA and ANB were significantly greater in the treatment groups, the value for SNB also increased in the control group (p < 0.05). The results of the stereophotogrammetry analyses demonstrated that the mean changes in the RPE/FM and in the Alt-RAMEC/FM groups were significantly different for the midface compared to the control group (0.33 ± 0.26 mm, 0.3 ± 0.31 mm, 0.1 ± 0.18 mm). The maximum positive, negative, and mean changes were also significantly different between the treatment and control groups for the upper lip (p < 0.05). For the lower lip and the chin significant backward movements in the RPE/FM as well as in the Alt-RAMEC/FM group (-1.06 ± 1.26 mm, -0.68 ± 0.45 mm) were observed, while the control group (0.09 ± 0.53 mm) presented changes in the opposite direction. Regarding soft tissue changes, no significant differences were found between the RPE/FM and Alt-RAMEC/FM groups. Both treatment protocols improved the soft tissue profile due to aforward movement of the midface and the upper lip, and abackward movement of the lower lip and chin, compared to the control group.

What is the Oral Health-related Quality of Life following Miniscrew-Assisted Rapid Palatal Expansion (MARPE)? A prospective clinical cohort study

BackgroundMiniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical orthodontic treatment for transverse maxillary deficiency. This study aimed to investigate the Oral Health-related Quality of Life (OHRQoL) and pain perception of patients undergoing MARPE treatment.Methods42 consecutive patients (9 men, 33 women) from the age of 16 onwards (mean: 27.4 ± 9.3 years; range 17.1–55.7 years) who received a MARPE treatment were included. OHRQoL was assessed with the short form of the Oral Health Impact Profile (OHIP-14) questionnaire. Patients filled out the questionnaire at baseline (T0) and weekly during the expansion phase (P1) and in the post-expansion phase (P2). Pain intensity was assessed with a Visual Analogue Scale (VAS) questionnaire and filled out daily during expansion, along with a question on the intake of analgesics. The mean weekly and total OHIP-score and OHIP-score per domain were calculated at T0, P1 and P2, as well as mean weekly and total VAS-scores for average pain, maximum pain and analgesics intake during P1. Kruskal–Wallis tests were used to test for differences in OHIP between T0, P1 and P2. The level of significance was set at 0.05.ResultsThe mean OHIP-score was 10.86 ± 9.71 at T0 and increased to 17.18 ± 10.43 during P1 (p < 0.001), after which it returned to pre-expansion levels, 9.27 ± 7.92 (p = 0.907) during P2. At the domain level, there was a statistically significant increase in OHIP-score at P1 for functional limitation, physical pain, psychological discomfort and social disability. The mean VAS-score for average pain during expansion was 16.00 ± 19.73 mm. Both OHIP-score (25.00 ± 10.25), average pain (33.72 ± 16.88 mm), maximum pain (44.47 ± 17.99 mm) and analgesics intake (59%) were highest at initiation of the expansion and decreased by the end of expansion.ConclusionsMARPE is a generally well-tolerated expansion treatment. A temporary decline in OHRQoL and moderate pain are present at the start of expansion, followed by a recovery of OHRQoL and very mild pain during the rest of treatment. Clinicians should be aware of the effects of MARPE on patients’ quality of life and manage the expected discomfort and impediments with adequate communication and patient education.

Changes in hyoid bone and tongue position in Class I subjects after orthodontic treatment with rapid palatal expander

ABSTRACT Objective To evaluate the effects of the rapid palatal expander (RPE) on the hyoid bone and tongue position in skeletal Class I patients, compared to control groups. Methods Eighty-four Class I subjects, aged 6–14, were selected. Among these, 28 patients were treated with RPE, 28 with function-generating bite (FGB) appliance, and 28 were untreated. Lateral cephalograms taken before (T0) and after (T1) treatment were retrieved. Changes in the hyoid bone and tongue position were evaluated, and the area above the tongue was measured. Results No significant difference in the hyoid and tongue posture was observed across the groups. However, there were significant differences for HC3 (distance from H-point to the third cervical vertebrae), H2H (distance from H-point to SN plane), and TT-Eb (tongue length) between T0 and T1 in all groups. Conclusion The results suggest that hyoid bone and tongue position changes were related to growth rather than treatment.

Rapid maxillary expansion-A review

Maxillary expansion treatments have been used for more than a century to correct maxillary transverse deficiency. Three expansion treatment modalities are used today: rapid maxillary expansion (RME), slow maxillary expansion (SME) and surgically assisted maxillary expansion. Since each treatment modality has advantages and disadvantages, controversy regarding the use of each exists. Rapid Maxillary expansion or palatal expansion as it is sometimes called, occupies unique niche in dentofacial therapy. Rapid Maxillary expansion is a skeletal type of expansion that involves the separation of the mid-palatal suture and movement of the maxillary shelves away from each other.

Slow expansion in orthodontics -A review article

One of the most common problems faced by an orthodontist while treating young as well as adult patients is the constricted maxillary arch. Expansion of the maxillary arch has been a topic of debate since centuries. The commonly used methods for constricted arch include slow maxillary expansion, rapid maxillary expansion and surgically assisted rapid palatal expansion (SARPE). Slow palatal expansion is a procedure to expand the maxillary arch in transverse dimension to correct the constricted maxillary arch with light forces. The following review article provides detailed information of various slow maxillary expansion appliances with their implications in orthodontics.

Buccal fat pad as a sealant in palatal mucosa tearing: technical note

For patients with a dentofacial deformity undergoing a planned segmentation of the maxilla for the management of a transverse maxillary arch discrepancy, palatal mucosa tearing may occur during sawing or palatal expansion traction, giving rise to an oronasal communication. This technical note describes the covering of a tear in the palatal mucosa using a buccal fat pad (BFP) flap, in the context of maxillary segmentation during Le Fort I osteotomy. Through the limited buccal incision used for the Le Fort I osteotomy, a small incision is made in the right periosteum posteriorly, and a supraperiosteal dissection is performed to access the BFP. After a sufficient amount of flap is made available, it is gently introduced through the osteotomy gap until it reaches the palatal mucosa defect and is then sutured. In the patient case presented, the palatal mucosa healed fully within 18 days, and the patient reported no nasal regurgitation of food, defective speech, fetid odour, bad taste, or upper respiratory tract or ear infection during the postoperative period. This technique using a BFP flap should therefore be considered in the context of unexpected tearing of the palatal mucosa in patients undergoing a segmented Le Fort I osteotomy.

Review on the Skeletal Effects of Rapid Palatal Expansion in Late Mixed Dentition

Review on the Skeletal Effects of Rapid Palatal Expansion in Late Mixed Dentition

Surgically assisted rapid palatal expansion: is the pterygomaxillary disjunction necessary? A finite element study

Transverse discrepancy is an important factor in determining facial esthetics. It has been shown there is an inverse correlation between the buccal corridor width and the intercanine and intermolar widths. Despite the fact midpalatal expansion is the treatment of choice for growing subjects, for skeletally mature subjects the rapid palatal expansion has limited orthopedic effects, and surgically assisted rapid palatal expansion (SARPE) is preferred. SARPE has shown inconsistencies depending on the surgical technique and/or expander device design. Some authors suggest that median and lateral osteotomies are sufficient to achieve the desired transverse dimensions using the SARPE procedure, while others recommend additional surgical separation of the pterygomaxillary junction. There are still controversies regarding the pterygomaxillary sutures (PMS) disjunction effect. Therefore, this study aimed to evaluate the displacement and stress distribution of the craniofacial structures resulting from SARPE, either with or without PMS osteotomy, using two different expander design (tooth-borne and tooth-bone-borne) using finite element method and finite element analysis (FEM/FEA). Regardless of the maxillary expander device type, both SARPE surgical techniques effectively produced maxillary expansion. SARPE with PMS osteotomy presented parallel maxillary expansion, and reduced stress values in the craniofacial and maxillofacial structures.

Condylar morphology and position changes after miniscrew-assisted rapid palatal expansion in skeletal Class III malocclusion adult patients with mandibular deviation and unilateral posterior crossbite

BackgroundTo evaluate the morphological and positional changes of mandibular condyle after miniscrew-assisted rapid palatal expansion (MARPE) in skeletal Class III malocclusion adult patients with horizontal mandibular deviation (MD).MethodsThe sample consisted of 15 patients with MD (6 males and 9 females, mean age 21.58 ± 3.12 years). The CBCT scans were taken before and after MARPE immediately. The pre- and post-registered images of the cranial base and mandible were measured, respectively, by Mimics.ResultsAfter expansion, the distance between superior condylar point and the Frankfort horizontal plane on the deviated side and the non-deviated side increased by 0.96 ± 0.60 mm (P = 0.011) and 0.70 ± 0.65 mm (P = 0.046); coronal condylar angle of the deviated side increased by 0.39° ± 0.34 (P = 0.028) and 0.06° ± 0.49 (P = 0.917) on the non-deviated side. No statistically significant differences were found when comparing the condylar position on both sides before and after treatment. The degree of mandibular deviation decreased 0.43 mm (P = 0.270).ConclusionsThis study suggested that for skeletal Class III malocclusion adult patients with horizontal MD, the condyle on the deviated side rotated toward the non-deviated side in the coronal direction; the condylar remodeling occurred mainly on the deviated side after MARPE in the vertical direction.

A retrospective analysis of the complications associated with miniscrew-assisted rapid palatal expansion

Miniscrew-assisted rapid palatal expansion (MARPE) has recently been advocated as a treatment option for older adolescents and adult patients with maxillary transverse deficiencies. This study aimed to identify the complications associated with MARPE and the frequency of their occurrences. A retrospective analysis was conducted on 256 patients (mean age, 18.8 ± 8.6; 126 females and 130 males) who underwent MARPE at a private practice and a graduate orthodontic clinic. Specific complications and their severity were identified by reviewing clinical notes and photographs. Asymmetric expansion was measured for patients who had cone-beam computed tomography scans taken before MARPE and immediately after expansion. The midpalatal suture was separated in 87.8% of patients. The most common complication was gingival inflammation around the appliance, found in 83.9% of patients. 45% of patients reported some form of pain during and after expansion. Appliance breakage occurred in 10% of patients. 47.8% of patients showed >1 mm of asymmetric expansion. Rare complications included tooth discoloration (potentially indicative of tooth vitality loss), temporary hearing loss, numbness, swelling, severe gag reflex, and sinus infection. The most common complication was gingival inflammation followed by pain; major and long-term complications were rare with MARPE. Overall, patients should be informed that gingival inflammation and pain are common side effects of MARPE and that rare complications can occur. Although asymmetric expansion was common after the palatal split, most patients were managed with orthodontic treatment.

Skeletal Changes after Miniscrew-assisted Rapid Palatal Expansion in Young Adults: A Cone-beam Computed Tomography Technique Study

Skeletal Changes after Miniscrew-assisted Rapid Palatal Expansion in Young Adults: A Cone-beam Computed Tomography Technique Study

Assessment of forces exerted by Haas and Hyrax palatal expanders using fiber optic sensors

Objective: To evaluate the initial forces generated by two types of palatal expansion appliances, through fiber optic sensors, in elastomeric models. Materials and Methods: An elastomeric model simulating the upper dental arch was fabricated. The sensors were placed adjacent to the first premolars and the first molars roots (apical, cervical, vestibular, palatal). Hyrax and Haas palatal expanders were fitted onto the dental arch. Activation of the screw was performed 4 times. The variations in wavelengths of each sensor during the activations were recorded. ANOVA and Games-Howell were used (P &lt;.05). Results: In the first premolars, the force generated by Hyrax was higher than that generated by Haas in the cervical and apical regions of the palatal and vestibular surfaces, respectively; in the first molars, the force was higher in the cervical vestibular region than that in the cervical palatal region for both the appliances; in Hyrax, the force was higher in the apical vestibular than in the apical palatine in tooth 14 (P &lt;.05). There was no difference between the devices for each activation; the total force generated by Hyrax was equal to that of Haas (P &lt;.05). Conclusions: The fiber optic sensors were effective in measuring the initial forces generated by the studied palatal expanders. Hyrax and Haas palatal expanders produced similar forces. Greater force was recorded on the vestibular surfaces.

Skeletal, Dentoalveolar and Dental Changes after "Mini-Screw Assisted Rapid Palatal Expansion" Evaluated with Cone Beam Computed Tomography.

The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping.

Effects on Muscular Activity after Surgically Assisted Rapid Palatal Expansion: A Prospective Observational Study.

The study aims to investigate the modifications in the temporalis and the masseter activity in adult patients before and after SARPE (Surgically Assisted Rapid Palatal Expansion) by measuring electromyographic and electrokinesographic activity. 24 adult patients with unilateral posterior crossbite on the right side were selected from the Orthodontic Department of the University of Milan. Three electromyographic and electrokinesographic surface readings were taken respectively before surgery (T0) and 8 months after surgery (T1). The electromyographic data of both right and left masseter and anterior temporalis muscles were recorded during multiple tests: standardized maximum voluntary contraction (MVC)s, after transcutaneous electrical nerve stimulation (TENS) and at rest. T0 and T1 values were compared with paired Student’s t-test (p < 0.05). Results: Significant differences were found in the activity of right masseter (p = 0.03) and right temporalis (p = 0.02) during clench, in the evaluation of right masseter at rest (p = 0.03), also the muscular activity of masseters at rest after TENS from T0 to T1 (pr = 0.04, pl = 0.04). No significant differences were found in the activity of left masseter (p = 0.41) and left temporalis (p = 0.39) during clench and MVC, in the evaluation of left masseter at rest (p = 0.57) and in the activity during MVC of right masseter (p = 0.41), left masseter (p = 0.34), right temporalis (p = 0.51) and left temporalis (p = 0.77). Results showed that the activity of the masseter and temporalis muscles increased significantly after SARPE during rest and clenching on the side where the cross-bite was treated.

A Guide to Orthodontic Devices for Trainees in Orthognathic Surgery

Purpose: Despite the interplay between orthodontics and orthognathic surgery, trainees in plastic surgery and oral and maxillofacial surgery do not receive formal training in orthodontics and associated hardware. This study aims to help surgical trainees better understand the role of orthodontic treatment in achieving enhanced dental occlusion and alignment and optimize surgical decision making. Methods: A review of recent literature was conducted to consolidate current practices for the use of orthodontic devices commonly used in orthognathic surgical patients. Results: Orthodontic treatments may be preventive, interceptive, and/or corrective. Braces and clear aligners are popular devices used to correct tooth positioning via 3 orders of control: first (“in-out” and rotation), second (mesio-distal angulation or “tip”), and third order (inclination or torque). Further, various treatments exist for skeletal and dental malocclusions, which may occur in transverse (crossbites, narrow arches) and/or sagittal (over/underbites) planes. Palatal expanders such as the Hyrax or Haas assist in correction of transverse deficiencies. Appliances for sagittal corrections typically take advantage of patient’s remaining growth and include a variety of headgear types (cervical, high-pull, occipital, reverse-pull), functional appliances (fixed or removable), or simply the use of interdental elastics. Conclusion: As patients are increasingly seeking orthodontic care in conjunction with surgery, it is important for surgical trainees to develop a strong understanding of the various orthodontic devices used.