Expansão Maxilar Apoiada em Mini-implantes (MARPE) – guia prático para planejamento e instalação

Rapid maxillary expansion (RME) is an orthodontic treatment alternative that aims to increase the transverse direction of the maxilla by separating the median palatine suture (MPS). miniscrew-assisted rapid palatal expansion (MARPE) aims to enhance the orthopedic effects of RME through skeletal anchorage. Thus, the aim of this article is to provide a guide for MARPE planning in cone beam computed tomography (CBCT) and for installation of the expander device with this technique. In addition, a case report of a Caucasian male patient, 16 years and 3 months old with Class II malocclusion, division 1 right subdivision, posterior crossbite of the right side and atresic upper arch in the post-pubertal growth spurt phase will be presented. The patient was treated with MARPE for a period of 5 weeks, when overcorrection of crossbite, correction of maxillary atresia, opening of MPS and creation of a transient diastema between the upper incisors were achieved, evidencing the success of the MARPE technique in a post-pubertal growth spurt patient.

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Comparison of skeletal maxillary transverse deficiency treated by microimplant-assisted rapid palatal expansion and tooth-borne expansion during the post-pubertal growth spurt stage:

The Angle Orthodontist ◽

10.2319/041920-332.1 ◽

2020 ◽

Vol 91 (1) ◽

pp. 36-45

Author(s):

Haichao Jia ◽

Li Zhuang ◽

Nan Zhang ◽

Yuanyuan Bian ◽

Song Li

Keyword(s):

Alveolar Bone ◽

Growth Spurt ◽

Height Loss ◽

Success Rates ◽

Pubertal Growth Spurt ◽

Palatal Expansion ◽

Rapid Palatal Expansion ◽

Pubertal Growth ◽

Before And After ◽

Bone Height

ABSTRACT Objective To investigate the efficacy of microimplant-assisted rapid palatal expansion (MARPE) to treat skeletal maxillary discrepancies during the post-pubertal growth spurt stage. Materials and Methods Sixty patients with skeletal maxillary transverse deficiency during the post-pubertal growth spurt stage were randomly divided into MARPE and Hyrax groups. Thirty patients (mean age: 15.1 ± 1.6 years) were treated using the four-point MARPE appliance; 30 patients (mean age, 14.8 ± 1.5 years) were treated using the Hyrax expander. Cone beam computed tomography scans and dental casts were obtained before and after expansion. The data were analyzed using paired t-tests and independent t-tests. Results The success rates of midpalatal suture separation were 100% and 86.7% for MARPE and Hyrax groups, respectively. Palatal expansion and skeletal to dental ratio at the first molar level were greater in the MARPE group (3.82 mm and 61.4%, respectively) than in the Hyrax group (2.20 mm and 32.3%, respectively) (P < .01). Reductions in buccal alveolar bone height and buccal tipping of the first molars were less in the MARPE group than in the Hyrax group (P < .01). Conclusions MARPE enabled more predictable and greater skeletal expansion, as well as less buccal tipping and alveolar height loss on anchorage teeth. Thus, MARPE is a better alternative for patients with skeletal maxillary deficiency during the post-pubertal growth spurt stage.

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Condylar Changes in Children with Posterior Crossbite after Maxillary Expansion: Tridimensional Evaluation

Children ◽

10.3390/children8010038 ◽

2021 ◽

Vol 8 (1) ◽

pp. 38

Author(s):

Rosamaria Fastuca ◽

Helga Turiaco ◽

Fausto Assandri ◽

Piero A. Zecca ◽

Luca Levrini ◽

...

Keyword(s):

Rapid Maxillary Expansion ◽

3D Analysis ◽

Maxillary Expansion ◽

3D Slicer ◽

Palatal Expansion ◽

Posterior Crossbite ◽

Rapid Palatal Expansion ◽

Before And After ◽

Condylar Position ◽

Caucasian Patients

(1) Background: To investigate condylar position in subjects with functional posterior crossbite comparing findings before and after rapid maxillary expansion (RME) treatment through 3D analysis; (2) Methods: Thirty-two Caucasian patients (14 males, mean age 8 y 8 m ± 1 y 2 m; 18 females mean age 8 y 2 m ± 1 y 4 m) with functional posterior crossbite (FPXB) diagnosis underwent rapid palatal expansion with a Haas appliance banded on second deciduous upper molars. Patients’ underwent CBCT scans before rapid palatal expansion (T0) and after 12 months (T1). The images were processed through 3D slicer software; (3) Results: The condylar position changes between T1 and T0 among the crossbite and non-crossbite sides were not statistically significant, except for the transversal axis. At T1, the condyles moved forward (y axis) and laterally (x axis), they also moved downward (z axis) but not significantly; (4) Conclusions: Condilar position in growing patients with functional posterior crossbite did not change significantly after rapid maxillary expansion.

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Use of a Modified Twin Block Appliance following Partial Maxillectomy: Case Report

British Journal of Orthodontics ◽

10.1179/bjo.23.2.103 ◽

1996 ◽

Vol 23 (2) ◽

pp. 103-108 ◽

Cited By ~ 1

Author(s):

H. C. Moseley ◽

E. N. Horrocks ◽

R. R. Welfare

Keyword(s):

Case Report ◽

Orthodontic Treatment ◽

Class Ii ◽

Growth Spurt ◽

Class Ii Malocclusion ◽

Pubertal Growth Spurt ◽

Twin Block ◽

Pubertal Growth ◽

Skeletal Pattern ◽

The Right

A case is described in which a Class II malocclusion with severe Class II skeletal pattern was treated with a modified Twin Block Appliance. The patient, an II-year-old girl, had initially presented with an ameloblastoma located in the right maxilla. The subsequent defect produced by surgery was obturated by the appliance during her orthodontic treatment, which was undertaken during her pubertal growth spurt Two years later the result was stable, allowing the provision of a more definitive prothesis to restore the occlusion.

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

Sensors ◽

10.3390/s20072086 ◽

2020 ◽

Vol 20 (7) ◽

pp. 2086

Author(s):

Fabiola Spolaor ◽

Martina Mason ◽

Alberto De Stefani ◽

Giovanni Bruno ◽

Ottavia Surace ◽

...

Keyword(s):

Surface Electromyography ◽

Healthy Subjects ◽

Subsequent Growth ◽

Activation Patterns ◽

Palatal Expansion ◽

Posterior Crossbite ◽

Rapid Palatal Expansion ◽

Different Types ◽

Before And After ◽

The Right

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.

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Time and pattern of the fusion of the spheno-occipital synchondrosis in patients with skeletal Class I and Class III malocclusion

The Angle Orthodontist ◽

10.2319/052218-386.1 ◽

2018 ◽

Vol 89 (3) ◽

pp. 470-479

Author(s):

Jae-Hee Yang ◽

Bong-Kuen Cha ◽

Dong-Soon Choi ◽

Jae Hyun Park ◽

Insan Jang

Keyword(s):

Computed Tomography ◽

Class I ◽

Cone Beam ◽

Growth Spurt ◽

Class Iii ◽

Class Iii Malocclusion ◽

Pubertal Growth Spurt ◽

Skeletal Class ◽

Pubertal Growth ◽

Stage System

ABSTRACT Objectives: To investigate the time and pattern of fusion of the spheno-occipital synchondrosis in patients with skeletal Class I and Class III malocclusion using cone-beam computed tomography (CBCT). Materials and Methods: A total of 262 CBCT images were collected: 140 skeletal Class I (0° < ANB < 4°; 71 males, 69 females) and 122 skeletal Class III (ANB ≤ 0°; 61 males and 61 females). The fusion stages were identified using CBCT images of a six-stage system defined by the appearance of osseous cores and ossifying vestige in the synchondrosis. The age distributions of each stage and the pattern of fusion were evaluated. Results: The stages of fusion progressed with increasing age (P < .05, r = .824), and the age distributions in the female groups were generally 1 to 3 years younger than those in the male groups. However, no significant differences were observed between the skeletal Class I and Class III groups regarding the time of ossification of the synchondrosis. The osseous cores appeared most frequently in the supero-center part, followed by the mid-center part of the synchondrosis. Conclusions: The time and pattern of fusion of the spheno-occipital synchondrosis are not apparently different between patients with Class I malocclusion and those with Class III malocclusion. The osseous cores appear frequently in the supero-center and mid-center of the synchondrosis with various patterns before the end of the pubertal growth spurt period.

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Correction of transverse maxillary deficiency and anterior open bite in an adult Class III skeletal patient

APOS Trends in Orthodontics ◽

10.4103/2321-1407.183156 ◽

2016 ◽

Vol 6 ◽

pp. 166-170

Author(s):

Prerna Hoogan Teja ◽

Samarjit Singh Teja ◽

Rabindra S. Nayak ◽

Abhijit Bagade ◽

Manu Rashmi Sharma

Keyword(s):

Transverse Dimension ◽

Open Bite ◽

Class Iii ◽

Maxillary Expansion ◽

Anterior Open Bite ◽

Palatal Expansion ◽

Posterior Crossbite ◽

Rapid Palatal Expansion ◽

Dental Crowding ◽

Maxillary Deficiency

Transverse maxillary deficiency may be associated with sagittal or vertical problems of the maxilla or mandible. It may contribute to unilateral or bilateral posterior crossbite, anterior dental crowding, and unesthetic black buccal corridors on smiling. An adequate transverse dimension is important for stable and proper functional occlusion. Surgically, assisted rapid palatal expansion has been the treatment of choice to resolve posterior crossbite in skeletally mature patients. The following case report presents an adult Class III skeletal patient with an anterior open bite and bilateral posterior crossbite which was treated by surgically assisted rapid maxillary expansion with satisfactory outcomes.

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Comparative dimensional tomographic study of the mandibular condyle of individuals with transverse maxillary deficiency

Brazilian Journal of Oral Sciences ◽

10.20396/bjos.v15i4.8650028 ◽

2017 ◽

Vol 15 (4) ◽

pp. 242

Author(s):

Andréa Guedes Barreto Gonçales ◽

Victor Tieghi Neto ◽

Eduardo Sanches Gonçales ◽

Ana Lúcia Álvares Capelozza

Keyword(s):

Computed Tomography ◽

Statistical Analysis ◽

Mandibular Condyle ◽

Cone Beam ◽

Maxillary Expansion ◽

Palatal Expansion ◽

Rapid Palatal Expansion ◽

Maxillary Deficiency ◽

Posterior Anterior ◽

Paired T Test

Transverse maxillary deficiency is characterized by posterior uni or bilateral crossbite, crowded and rotated teeth, as well as high palate. Its treatment in adult individuals is surgically assisted rapid palatal expansion. The aim of this study was to verify the occurrence of dimensional alterations in the mandibular condyles of patients with TMD submitted to surgically assisted maxillary expansion. Measurements of the mandibular condyles using the DISTANCE tool in cone beam computed tomography iCat software were performed. The values obtained were submitted to statistical analysis by the paired t-test and the results showed statistically significant dimensional reduction in the axial posterior-anterior lateral (-0.74mm), axial posterior-anterior lateral left (-0.90mm) and coronal medium right (-1.24mm) dimensions. The coronal inferior (1.13mm), coronal inferior left (1.78mm) and coronal superior-inferior right (0.76mm) measurements showed statistically significant dimensional increase. The results allowed us to conclude that dimensional alterations occurred in the mandibular condyles in individuals with maxillary transversal deficiency that underwent surgically assisted rapid palatal expansion (SAPE), which can be understood by remodeling, since they are characterized by dimensional increase or reduction, depending on the location where the measurement was performed.

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RAPID PALATAL EXPANSION AND ITS FEATURES

ASJ. ◽

10.31618/asj.2707-9864.2020.2.40.23 ◽

2020 ◽

Vol 2 (40) ◽

pp. 20-22

Author(s):

A.K. Al Dzhafari ◽

S.A. Ulyanovskaya

Keyword(s):

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Maxillofacial Region ◽

Posterior Teeth ◽

Anatomical Features ◽

Palatal Expansion ◽

Rapid Palatal Expansion ◽

Congenital Deformities ◽

Upper Jaw ◽

Mid Palatal Suture

Rapid Maxillary expansion or palatal expansion as it is sometimes called, occupies unique niche in dentofacial therapy. Rapid Maxillary expansion (RME) 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. RME effects the maxillary complex, palatal vaults, maxillary anterior and posterior teeth, adjacent periodontal structures to bring about an expansion in the maxillary arch. Morphogenesis and anatomical features of the upper jaw determine the choice of the method of rapid palatal expansion with narrowing of the upper dentition, as an effective method for eliminating congenital deformities of the maxillofacial region. The majority of dental transverse measurements changed significantly as a result of RME. The maturity of the maxillofacial structures determines the timing and degree of success of rapid palatal dilatation treatment.

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Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis

European Journal of Orthodontics ◽

10.1093/ejo/cjab005 ◽

2021 ◽

Author(s):

Aldin Kapetanović ◽

Christina I Theodorou ◽

Stefaan J Bergé ◽

Jan G J H Schols ◽

Tong Xi

Keyword(s):

Systematic Review ◽

Success Rate ◽

Observational Studies ◽

Risk Of Bias ◽

Late Adolescents ◽

Maxillary Expansion ◽

Palatal Expansion ◽

Rapid Palatal Expansion ◽

Adolescents And Adults ◽

Maxillary Deficiency

Summary Background Miniscrew-Assisted Rapid Palatal Expansion (MARPE) is a non-surgical treatment for transverse maxillary deficiency. However, there is limited evidence concerning its efficacy. Objectives This systematic review aims to evaluate the efficacy of MARPE in late adolescents and adults by assessing success rate and skeletal and dental transverse maxillary expansion, as well as treatment duration, dental and periodontal side effects and soft tissue effects. Search methods Seven electronic databases were searched (MEDLINE, Embase, Cochrane Library, Web of Science, Scopus, ProQuest and ClinicalTrials.gov) without limitations in November 2020. Selection criteria Randomized and non-randomized clinical trials and observational studies on patients from the age of 16 onwards with transverse maxillary deficiency who were treated with MARPE and which included any of the predefined outcomes. Data collection and analysis Inclusion eligibility screening, data extraction and risk of bias assessment were performed independently in duplicate. When possible, exploratory meta-analyses of mean differences (MDs) with their 95% confidence intervals (CIs) were conducted, followed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis of the evidence quality. Results Eight articles were included: two prospective and six retrospective observational studies. One study had a moderate risk of bias, whereas seven studies had a serious risk of bias. GRADE quality of evidence was very low. MARPE showed a high success rate (mean: 92.5%; 95%CI: 88.7%–96.3%), resulting in a significant skeletal width increase (MD: 2.33 mm; 95%CI: 1.63 mm–3.03 mm) and dental intermolar width increase (MD: 6.55 mm; 95%CI: 5.50 mm–7.59 mm). A significant increase in dental tipping, a decrease in mean buccal bone thickness and buccal alveolar height, as well as nasal soft tissue change was present (P < 0.05). The mean duration of expansion ranged from 20 to 126 days. Limitations One of the main drawbacks was the lack of high-quality prospective studies in the literature. Conclusions and implications MARPE is a treatment modality that is associated with a high success rate in skeletal and dental maxillary expansion. MARPE can induce dental and periodontal side effects and affect peri-oral soft tissues. Given the serious risk of bias of the included studies, careful data interpretation is necessary and future research of higher quality is strongly recommended. Registration PROSPERO (CRD42020176618). Funding No grants or any other support funding were received.

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