Maxillary Transverse Discrepancy Research Articles

Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment

This study compared the skeletal and dental changes of microimplant assisted rapid palatal expansion (MARPE) with those produced by surgically assisted rapid maxillary expansion (SARPE) in postpeak adolescents and adults. The sample comprised 17 patients (mean age, 26±11years) selected for the MARPE group and 15 (mean age, 28.5±10.5years) selected for the SARPE group. Cone-beam computed tomography scans taken just before and after the expansion were used to assess dental and skeletal changes and compare the changes between the groups. MARPE showed greater transversal skeletal changes in the midface and posterior and anterior maxillary base measurements. The transverse displacement of the alveolar process was greater but not significant for the SARPE group than the MARPE group. Regarding dental effects, the root distance measurements did not differ between the groups, but SARPE produced a significantly greater increase in intermolar and interpremolar distance and a greater buccal inclination of the alveolar process and supporting teeth than MARPE. The MARPE technique showed an increase in skeletal transverse maxillary expansion at the midface and basal bone compared with SARPE, especially at the posterior palatal region; however, no difference was found in the expansion of the alveolar process between the 2 methods. MARPE presented a more parallel expansion in both a coronal and axial view, whereas SARPE led to a V-shaped opening. The greater buccal inclination of the alveolar process and supporting teeth was observed in the SARPE group.

Distrator ósseo transpalatal como opção para expansão maxilar: Relato de caso

A discrepância transversa da maxila é comumente observada em pacientes que procuram tratamento ortodôntico, para uma adequada oclusão. É frequentemente definida como uma mordida cruzada posterior e apinhamento dentário anterior. Várias abordagens estão disponíveis para tratar esta discrepância e alcançar a expansão maxilar, sendo conseguida através de técnicas, cirúrgicas e não cirúrgicas. A necessidade de se utilizar a técnica cirúrgica advém quando o paciente já atingiu a maturidade esquelética, desta forma é possível alcançar a dimensão correta da maxila por meio de aparelhos dento-muco-suportados, dento-suportados e ósseo-suportados. No presente caso, a utilização de um aparelho ósseo-suportado mostra vantagens clínicas significativas sobre as outras técnicas uma vez que não observa-se danos aos tecidos ou elementos dentais e sim efeitos exclusivos aos tecidos ósseos resultando em um aumento significativo do arco maxilar e melhora da oclusão, além de melhora respiratória.

Oropharyngeal 3-dimensional changes after maxillary expansion with 2 different orthodontic approaches

The objective of this research was to compare the oropharyngeal volume and minimal cross-sectional area (MCA) changes after maxillary expansion using either the Damon system or Hyrax appliances as assessed through cone-beam computed tomography (CBCT) imaging. Patients aged between 11 and 17years with skeletal maxillary transverse discrepancy in need of maxillary expansion were included and allocated randomly into 1 of the 2 treatment groups, Damon or Hyrax. Patients underwent CBCT imaging at 2 time points: T1, after initial clinical evaluation before treatment, and T2, after completion of full orthodontic treatment. The CBCT data were assessed using Dolphin software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). In addition, a qualitative assessment of breathing function was done using the modified Nasal Obstruction and Septoplasty Effectiveness Scale questionnaire. A statistically significant increase in the oropharyngeal volume (2.23mL; P=0.005) and MCA (29.72mm2; P=0.007) after the completion of treatment (T2 - T1) for the Hyrax group was suggested. No statistically significant difference was found in the Damon group for volume (1mL; P=0.311) and for MCA (7.32mm2; P=0.643). In addition, no statistically significant difference was found in the breathing function in both treatment groups (P>0.05). Hyrax expansion followed by fixed appliances produced more dimensional upper airway changes at the oropharyngeal level than the Damon system approach. No breathing functional changes were noted in either samples.

Tomographic analysis of midpalatal suture prior to rapid maxillary expansion.

ABSTRACTIntroduction: In Orthodontics and Facial Orthopedics, the timing of treatment onset may be critical and individual analysis should be applied to promote a favorable treatment planning. In this study, individual analysis of midpalatal suture (MS) and palatal measurements were performed in teenagers and young adult patients treated with rapid maxillary expansion (RME). Description: Twenty-six patients submitted to RME with a tooth-supported appliance (Hyrax) were evaluated. The inclusion criteria were: minimum age of 14 years, presenting all posterior teeth, diagnosed with transverse maxillary discrepancy, and with a clinical indication for maxillary expansion. The pretreatment CBCT scans of these patients were assessed to obtain the stages of MS maturation (MSM); density ratio (MSD); and palatal length, thickness (anterior, intermediate and posterior) and sagittal area. Results: The maturation stages present were C, D or E; the density ranged from 0.6 to 1, and lower density (MSD < 0.75) and higher density (MSD ≥ 0.75) groups were determined. Individuals with higher MSD presented smaller sagittal area, compared to the lower density group. Individuals in D and E MSM stages presented smaller sagittal area and intermediate thickness, compared to stage C. Conclusions: Smaller palatal sagittal area was observed in the high MSD groups and in the stages D and E of MSM.

Fabrication of feeding plate to an infant with Pierre-Robin syndrome: a case report

Cleft lip and palate is a congenital deformity associated with maxillary sagittal and transverse discrepancies. Feeding is an immediate concern in children born with a cleft as it delays their normal growth. A feeding plate is essential for proper nutrition, and it has a role in craniofacial development and decreases the incidence of otitis media and nasopharyngeal infections. This case report describes a single visit technique for fabrication of feeding prosthesis for a 5- day old new-born infant with cleft lip and palate. The prosthesis helps in reducing the flow of food into the nasopharynx, thus decreasing the incidence of Otis media and oro-nasopharyngeal infections.

Resident Commentary: Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances (Ploder et al, 2020)?

Resident Commentary: Is There a Significant Difference in Relapse and Complication Rate of Surgically Assisted Rapid Palatal Expansion Using Tooth-Borne, Bone-Borne, and Orthodontic Mini-Implant-Borne Appliances (Ploder et al, 2020)?

Maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion

The objective of the present study was to compare the maxillary dental and skeletal effects after treatment with self-ligating appliance and miniscrew-assisted rapid maxillary expansion (MARPE). The sample comprised 37 patients with Class I malocclusion treated without tooth extraction, divided into 2 groups: group 1 comprises 21 patients with a mean age of 19.55years (standard deviation=1.31), submitted to orthodontic treatment with Damon self-ligating appliance, and evaluated until the end of the alignment and leveling stage. Group 2 comprises 16 patients with a mean age of 24.92years (standard deviation=7.60), with maxillary atresia, who underwent MARPE, and were evaluated after the removal of the expander. Buccal bone thickness; dental inclinations; and transverse distances of the maxillary arch, nasal base, and jugula widths were measured on cone-beam computed tomography scans before and after treatment. The intergroup comparison was performed with the independent t test. With treatment, there was a significantly greater decrease in buccal bone thickness of canines and premolars in the self-ligating group, the premolars presented a greater buccal inclination in the self-ligating group, and the intercanine and intermolar distances and nasal base and jugula widths showed significantly greater increases in the MARPE group than in the self-ligating group. MARPE treated more severe skeletal transverse maxillary discrepancies and obtained better results than self-ligating appliances in terms of buccal bone loss, tooth inclination, and transverse skeletal increase of the maxilla. MARPE presented more skeletal effects and self-ligating appliances, more dental effects.

Evaluation of Tissue Tensions in Segmental Maxillary Osteotomies by Finite Element Analysis

Maxillary segmentation associated with Le Fort I osteotomy is a surgical technique used to correct transverse maxillary discrepancies. Notwithstanding advances over the years, there are still complications arising from this surgical intervention, including the maintenance of sufficient blood supply and excessive tension of the palatal fibromucosa. Therefore, the aim of this study was to analyze the effect of the force applied during surgery on bone dislocation and fibromucosa tension in different maxillary segmentation designs by finite element analysis. A 3-dimensional skull was generated from tomographic images. We worked with 4 models. In 2 models, we divided the maxilla into 3 segments: one with osteotomy between the lateral incisor and canine and the other between the canine and first premolar. In the other 2 models, we divided the maxilla into 4 segments with the same osteotomies previously mentioned. A force of 100N was applied to the palatal surfaces of the right and left permanent maxillary first molars. When comparing the technique between 3 and 4 segments with the same interdental osteotomy, we evidenced greater bone dislocation and less fibromucosa tension in the 3-segment technique. When we contrast the same number of segments with different regions of interdental osteotomy, we noticed a lower fibromucosa tension and a greater bone dislocation in the lateral incisors and canine. The technique with 3 segments and with interdental osteotomy between the lateral incisor and canine presented less resistance, allowing greater dislocation and consequently generating less mucosa tension.

A comparison of tooth-borne and bone-anchored expansion devices in SARME.

Major adult maxillary transverse discrepancies are usually treated with surgically assisted rapid maxillary expansion (SARME), utilizing a combination of surgical and orthodontic techniques. Unfortunately, a consensus has not been reached on topics ranging from the best surgical technique that should be performed to the ideal expander type that should be installed. The present study sought to evaluate the efficiency and stability of the maxillary expansion achieved with two types of expanders following the same SARME procedure without pterygomaxillary disjunction (PMD). Twenty-four patients with a maxillary transverse deficiency were enrolled in the study. All patients underwent the same SARME, and 12 received a bone-anchored (KLS Martin®) and 12 were installed with a tooth-borne (Hyrax®) expander. Dental impressions were collected both preoperatively and 1year postoperatively. These casts were scanned and the distances between specific interdental and intergingival points were measured and analyzed. Statistical analyses were performed to assess the effects expander type had on the efficiency of the maxillary expansion and long-term stability. Expansion in the anterior maxillary and premolar regions was found to be similar in both groups. In contrast, the tooth-borne device resulted in a significantly greater expansion in the molar region. The SARME technique without PMD is highly effective at treating adults with maxillary transverse deficiencies, and the type of expander selected depends on the location of the larger maxillary constriction region of each patient.

Effects of Rapid Palatal Expansion on Chewing Biomechanics in Children with Malocclusion: A Surface Electromyography Study.

Malocclusion during childhood may affect both morphology and masticatory function and could greatly affect the subsequent growth and development of the jaws and face. The purpose of this study was to evaluate the efficiency of surface electromyography in describing the effects of the rapid palatal expansion (RPE) on Masseter (M) and Temporalis Anterior (T) muscles’ activity in 53 children with different types of malocclusion: bilateral posterior crossbite (BPcb), underdeveloped maxillary complex without crossbite (NOcb) and unilateral posterior crossbite on the right (UPCBr) and on the left (UPCBl). The muscular activities during chewing tasks were assessed bilaterally before and after RPE application and three months after removal. Both the envelope’s peak (µV) and its occurrence (% of chewing task) were extracted from the surface electromyography signal. Our results showed the presence of statistically significant differences (p < 0.05) on temporomandibular joint muscles, across different assessments, in all the tested populations of subjects. Surface electromyography demonstrated a relationship between the correction of a maxillary transverse discrepancy and the restoration of a muscle’s activation patterns comparable to healthy subjects for both T and M.

Mechanical properties of the NiTi Memoria Leaf Spring Activated Expander (NiTi MLSAE) for maxillary transverse discrepancy correction: An in-vitro study.

BackgroundTo determine the mechanical properties of the NiTi Memoria® Leaf Spring Activated Expander (NiTi MLSAE) in two forms, unaltered (unbent) and altered (bent) to mimic clinical use. Material and MethodsThis in-vitro pilot study was conducted using eight NiTi MLSAE expanders (American Tooth Industries, Oxnard, California) representing four force magnitudes: 10mm 500g, 10mm 900g, 6mm 450g and 6mm 900g models. Two experiments were performed: the first tested the expanders in their unbent form and the second tested them after they were bent by one experienced technician. All expanders were adapted to a standard three dimensional printed maxillary study model. A Dillion Quantrol 500N (110lbf) load cell and a custom-made fixturing apparatus was used to determine the amount of expansive forces delivered. Prior to testing, the ligation compressing the NiTi MLSAE leaves was cut to allow the appliances to expand to their original form. Emperor™ (force) Software was used to measure the expansion forces. ResultsThe average expansion forces generated by the expanders were: unaltered = 897.4g (8.8N) and bent = 877.0g (8.6N) for the 10mm 900g model, unaltered = 489.5g (4.8N) and bent = 479.3g (4.7N) for the 10mm 500g model, unaltered = 458.9g (4.5N) and bent = 438.5g (4.3N) for the 6mm 450g model, and unaltered = 805.6g (7.9N) and bent = 785.2g (7.7N) for the 6mm 900g model. ConclusionsRegardless of whether the expander was straight or bent, the forces generated by the 10mm 900g, 10mm 500g and 6mm 450g Ni-Ti MLSAEs correlated with the benchmark study conducted by the manufacturer. However, the forces generated by the 6mm 900g Ni-Ti MLSAE were less than the data published by the manufacturer. Binding was observed when the expanders were manipulated to mimic clinical use, and this may account for the reported lower expansion force. Key words:Maxillary expansion, NiTi, posterior crossbite, malocclusion, maxillary transverse discrepancy.

Surgically-assisted rapid maxillary expansion (SARME): indications, planning and treatment of severe maxillary deficiency in an adult patient.

ABSTRACTIntroduction: Maxillary deficiency, also called transverse deficiency of the maxilla, may be associated with posterior crossbite, as well as with other functional changes, particularly respiratory. In adult patients, because of bone maturation and the midpalatal suture fusion, rapid maxillary expansion has to be combined with a previous surgical procedure to release the areas of resistance of the maxilla. This procedure is known as surgically-assisted rapid maxillary expansion (SARME). Objective: This study discusses the indications, characteristics and effects of SARME, and presents a clinical case of transverse and sagittal skeletal maxillary discrepancy treated using SARME and orthodontic camouflage.

Surgically Assisted Rapid Palatal Expansion to Correct Maxillary Transverse Deficiency.

Background:Transverse maxillomandibular discrepancies are widespread. Treatment is comprised of orthodontic expansion in patients younger than 15 years or by surgically assisted rapid palatal expansion (SARPE) in skeletally mature patients where the possibility of successful orthodontic maxillary expansion decreases as sutures close and resistance to mechanical forces increases.Aim:To present our experience of treating transverse maxillary deficiency using a unique L-shaped osteotomy and to demonstrate stable results.Patients and Methods:32 patients aged between 19 and 54 years exhibiting transverse maxillary deficiency. L-shaped osteotomy was performed laterally from the pterygoid plate posteriorly to above the roots of the second incisive anteriorly continuing with a vertical osteotomy between the lateral incisive and canine teeth toward the horizontal osteotomy. In 18 patients with dysgnathia, bimaxillary surgery was performed one year following the SARPE procedure.Results:Mean transverse maxillary expansion of 6.2mm at the canine incisal and 6.4mm at the first molar occlusal regions were obtained. One year postoperatively results were relatively stable, 5.8mm and 6.2mm respectively. The SARPE procedure resulted in overcoming the maxillary buttress resistance, expansion of the anterior dental arch and bilateral distraction creating bone on both sides of the premaxilla contributing to better alignment of the anterior teeth and superior stability.Conclusions:We conclude that SARPE is an effective and stable method for addressing severe maxillary transverse discrepancy in adults while the unique osteotomy performed allowed for maintaining proper position of the premaxilla and maxillary midline and allowing for division of the newly created bone bilaterally thus resulting in a more stable outcome.

Rapid correction of constricted maxillary arch in a class III patient using a corticotomy assisted expansion technique

This case report introduces a noval approach of corticotomy-assisted rapid maxillary expansion for treating a severe maxillary transverse discrepancy in an adult patient. This approach uses piezo-bone perforation in conjunction with a fixed appliance and expanded jockey arch wire. This report describes the treatment of an 18-year-old male with a severe maxillary transverse discrepancy. He had a straight profile, mild maxillary crowding, severe maxillary transverse deficiency and a Class III skeletal relationship. The treatment protocol commenced with active orthodontic therapy, after leveling and aligning surgical intervention with Piezocision assisted bone perforation was performed. Immediately after the piezo assisted bone perforation on bilateral buccal side of the maxilla, active expansion force was given with expanded jockey arch wire. The expanded jockey wire was left in place for 3 months. Proper overbite and overjet, facial balance, and occlusion were achieved. The case is in final stage of finishing. This treatment approach considerably reduced the treatment time and gained bony volume. This approach is a good alternative to surgical rapid palatal expansion for treating a severe maxillary transverse deficiency in an adult patient. Key words: Corticotomy, osteotomy, accelerated orthodontics, Piezocision

A Review on Rapid Maxillary Expansion

Rapid maxillary expansion (RME) is an orthopedic procedure that utilizes optimum forces to correct transverse maxillary arch discrepancies. There has been various designs of Rapid Maxillary Expanders that has evolved over time and their usage in various clinical conditions. It has been used not only to correct maxillary constriction but also to create additional space in the dental arches to relieve crowding. The review on the RME renders various evidence-based facts about types, designs and uses of RME appliances and promotes the better understanding of their biomechanical effects and their clinical implications among the orthodontic fraternity.

Surgical/Orthodontic Correction of Transverse Maxillary Discrepancies.

The transverse dimension is a critical component of comprehensive treatment in orthognathic surgery. Several treatment approaches exist and the team must consider the patient's needs, desires, and limitations when working to correct the malocclusion. Treatment approaches may include only orthodontic expansion or rapid palatal orthodontic expansion; however, in adults, the orthodontist may require surgical assistance to expand the bony maxilla. Segmental maxillary expansion may be indicated in severe transverse deficiencies of the maxillary arch or dentofacial deformity patients also requiring vertical and sagittal corrections. The various treatment options, advantages, and disadvantages, and indications for each surgical approach are discussed.

Expansion in the absence of crossbite – rationale and protocol

Transverse maxillomandibular discrepancies are a major component of several malocclusions. Clinically, posterior crossbite is a common and valid indicator of maxillary transverse problems and orthopedic and orthodontic forces are routinely used to correct maxillary transverse deficiency. However, crossbite and transverse discrepancies are not a homologous group but must be viewed as a continuum with varying degree of abnormality. The etiology, diagnostic protocol, rationale, and procedures employed for correcting maxillary transverse discrepancy in the absence of crossbite are discussed in the article.

Association between maxillary transverse discrepancy and occurrence of potentially impacted maxillary canines in mixed dentition patients

The aim of this study was to determine the association between transverse maxillary discrepancy and occurrence of potentially impacted maxillary canines in mixed dentition patients. This cross-sectional analytical study was conducted on 85 Pakistani subjects (32 males and 53 females) aged between 8 to 13 years, having good quality orthopantomographs and dental casts. Maxillary transverse discrepancy was assessed by subtracting the mandibular intermolar width from the maxillary intermolar width on dental cast. Maxillary lateral incisors and canines were traced from orthopantomographs, and canines were placed into sector classification. Chi-square test was used to determine the difference in the occurrence of potentially impacted maxillary canines between patients with maxillary transverse discrepancy and patients without maxillary transverse discrepancy. There was no significant difference seen in the occurrence of impacted maxillary canines in patients with and without maxillary transverse discrepancy in mixed dentition patients. Patients with maxillary transverse discrepancy may not be at a higher risk of palatal canine impaction. Radiological presence of canine in sector II, III and IV, pose a higher risk of canine impaction.

Role of transpalatal vault fixation with 2.0 plate for transverse palatal expansion in segmental le fort osteotomy

Background: Segmental Le Fort I osteotomy is a predictable, well-established surgical technique that is commonly used to correct maxillary transverse discrepancies up to 6–7 mm in adults. However, transverse expansion of the maxilla with a segmental Le Fort I osteotomy is often associated with postsurgical instability and relapse. Different methods have been recommended to reduce the potential for transverse instability involving bone grafts or allografts at the palatal osteotomy site, use of palatal bars and expanders, interocclusal splints and transpalatal bone-anchored devices. However, transverse maxillary expansion with a segmental Le Fort I osteotomy is still considered the least stable surgical orthognathic procedure and overexpansion with stable fication method frequently recommended.

Skeletal, Dentoalveolar, and Periodontal Changes of Skeletally Matured Patients with Maxillary Deficiency Treated with Microimplant-assisted Rapid Palatal Expansion Appliances: A Pilot Study

Introduction Microimplant-assisted rapid palatal expansion (MARPE) has recently been offered to adult patients for correcting maxillary transverse deficiency. However, there is limited information in the literature on the success of this appliance and its skeletal and dental effects on skeletally matured patients. The purpose of this study was to investigate the immediate skeletal, dentoalveolar, and periodontal response to MARPE appliance using cone-beam computed tomography in a skeletally matured patient as assessed by the cervical vertebral maturation method. Materials and Methods Eight consecutively treated patients (2 females, 6 males; mean age of 21.9 ± 1.5 years) treated with a maxillary skeletal expander were included in the study. Measurements were taken before and after expansion to determine the amount of midpalatal suture opening, upper facial bony expansion, alveolar bone bending, dental tipping, and buccal bone thickness (BBT). Data were analyzed using a one-way ANOVA and matched-pair t-test (α = 0.05). Results Midpalatal suture separation was found in 100% of the patients with no dislodged microimplants. Total maxillary expansion was attributed to 41% skeletal, 12% alveolar bone bending, and 48% dental tipping. Pattern of midpalatal suture opening was found to be parallel in both the coronal and axial planes. On average, the absolute dental tipping ranged from 4.17° to 4.96° and the BBT was reduced by an average of 39% measured at the premolars and molars. Conclusions The MARPE appliance can be a clinically acceptable, nonsurgical treatment option for correcting mild to moderate maxillary transverse discrepancies for skeletally matured adult patients with a healthy periodontium.