Analysis of dental and skeletal changes after Rapid Maxillary Expansion – CBCT and 3-D digital model – case report

The Alt-RAMEC protocol was introduced by Liou in the year 2005. It allows for sutural mobilisation by opening and closing the RME screw for 7-9 weeks. Maxillary protraction after the use of Alt-Ramec (alternate rapid maxillary expansion and contraction) protocol is an efficient method for early treatment of skeletal Class III malocclusion. This case report shows the results of using a hyrax bonded maxillary expander with the Alt-RAMEC protocol to treat a maxillary hypoplasia Class III malocclusion. A 12-year-old patient with skeletal class III malocclusion with anterior as well as the unilateral posterior crossbite was treated using this protocol. CBCT scans were taken before and after expansion. These CBCT scans were used for assessing and analysing the skeletal changes that have occurred after using the AltRamec protocol. The objective of this case report is to assess skeletal changes after using the Alt-RAMEC protocol.

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Treatment of Unilateral Cleft Lip and Palate Patient With Intraoral Tooth Tissue Borne Distractor and Facemask Therapy: A Case Report

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665621993366 ◽

2021 ◽

pp. 105566562199336

Author(s):

Akansha Bansal Agrawal ◽

Harshavardhan Kidiyoor ◽

Anand K. Patil Morth

Keyword(s):

Case Report ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Face Mask ◽

Rapid Maxillary Expansion ◽

Growth Potential ◽

Maxillary Expansion ◽

Long Term Stability ◽

Tooth Tissue

This case report demonstrates the successful use of intraoral distractor/hygenic rapid expander (HYRAX) for rapid maxillary expansion in anteroposterior direction with an adjunctive use of face mask therapy for anterior orthopedic traction of maxillary complex in a cleft patient with concave profile. The patient was a 13-year-old girl who reported with a chief complaint of backwardly positioned upper jaw and a severely forward positioned lower jaw. Therefore, a treatment was chosen in which acrylic bonded rapid maxillary expansion was done with tooth tissue borne intraoral distractor/HYRAX having a different activation schedule along with Dr Henri Petit facemask to treat maxillary retrognathism. As a result, crossbite got corrected and attained a positive jet with no bone loss in cleft area over a period of 5 months which was followed by fixed mechanotherapy achieving a well settled occlusion in 1 year. After completion of expansion and fixed mechanotherapy, ANB became +1 post-treatment which was −4 pretreatment. The prognathic profile was markedly improved by expansion and taking advantage of the remaining growth potential, thus minimizing the chances of surgery later in life. This provided a viable alternative to orthognathic surgery with good long-term stability.

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Skeletal alterations associated with the use of bonded rapid maxillary expansion appliance

Brazilian Dental Journal ◽

10.1590/s0103-64402011000400013 ◽

2011 ◽

Vol 22 (4) ◽

pp. 334-339 ◽

Cited By ~ 9

Author(s):

Moara de Rossi ◽

Andiara de Rossi ◽

Jorge Abrão

Keyword(s):

Rapid Maxillary Expansion ◽

Growth Patterns ◽

Facial Growth ◽

Maxillary Expansion ◽

Skeletal Changes ◽

End Of Treatment ◽

The Face ◽

Vertical Changes ◽

Skeletal Effects ◽

Cephalometric Study

Bonded maxillary expansion appliances have been suggested to control increases in the vertical dimension of the face after rapid maxillary expansion (RME). However, there is still no consensus in the literature about its real skeletal effects. The purpose of this prospective study was to evaluate, longitudinally, the vertical and sagittal cephalometric alterations after RME performed with bonded maxillary expansion appliance. The sample consisted of 26 children, with a mean age of 8.7 years (range: 6.9-10.9 years), with posterior skeletal crossbite and indication for RME. After maxillary expansion, the bonded appliance was used as a fixed retention for 3.4 months, being replaced by a removable retention subsequently. The cephalometric study was performed onto lateral radiographs, taken before treatment was started, and again 6.3 months after removing the bonded appliance. Intra-group comparison was made using paired t test. The results showed that there were no significant sagittal skeletal changes at the end of treatment. There was a small vertical skeletal increase in five of the eleven evaluated cephalometric measures. The maxilla displaced downward, but it did not modify the facial growth patterns or the direction of the mandible growth. Under the specific conditions of this research, it may be concluded that RME with acrylic bonded maxillary expansion appliance did promote signifciant vertical or sagittal cephalometric alterations. The vertical changes found with the use of the bonded appliance were small and probably transitory, similar to those occurred with the use of banded expansion appliances.

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Orthodontic Treatment of a Cleft Palate Patient with Surgically Assisted Rapid Maxillary Expansion

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1996_033_0445_otoacp_2.3.co_2 ◽

1996 ◽

Vol 33 (5) ◽

pp. 445-449 ◽

Cited By ~ 5

Author(s):

Takafumi Susami ◽

Takayuki Kuroda ◽

Teruo Amagasa

Keyword(s):

Case Report ◽

Cleft Palate ◽

Orthodontic Treatment ◽

Rapid Maxillary Expansion ◽

Third Molars ◽

Maxillary Expansion ◽

Anterior Maxilla ◽

Posterior Crossbite ◽

Palate Patient ◽

Suture Opening

Some adult cleft palate patients show severe maxillary transverse contraction and posterior crossbite. This case report demonstrates successful surgical-orthodontic treatment of such a patient. Surgically assisted rapid maxillary expansion (SA-RME) was completed prior to comprehensive orthodontic treatment. The osteotomy was performed on both the buccal and lingual aspects of the posterior maxillary alveolus. A Hyrax-type maxillary-expansion appliance was used, and the screw (0.2 mm, one quarter turn) was turned two or three times per day. Comprehensive orthodontic treatment was initiated after extraction of the mandibular first premolars and four third molars. The maxillary lateral incisors were also extracted after active orthodontic treatment. The amount of expansion achieved using SA-RME was greater at the posterior than at the anterior maxilla. Midpalatal suture opening occurred. After orthodontic treatment, occlusal stability was satisfactory. This case demonstrates the effectiveness of SA-RME in adult cleft palate patients with severe posterior crossbite.

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Comparison of the effects of rapid maxillary expansion versus Twin Block appliance on mandibular growth in skeletal Class II patients

BMC Oral Health ◽

10.1186/s12903-020-01344-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jia-Nan Zhang ◽

Si Chen ◽

Cheng-Yi Huang ◽

Chong Zhong ◽

Jing Jin ◽

...

Keyword(s):

Class Ii ◽

Rapid Maxillary Expansion ◽

Maxillary Expansion ◽

Fixed Appliance ◽

Mandibular Growth ◽

Twin Block ◽

Skeletal Class ◽

Skeletal Changes ◽

Skeletal Class Ii ◽

Growth Changes

Abstract Background This is a retrospective study that compares mandibular growth changes in skeletal Class II patients treated by rapid maxillary expansion (RME) and following fixed appliance with those patients treated by Twin-Block (TB) and following fixed appliance. Methods Fourteen patients treated by RME and following fixed appliance were included into the RME group. Fifteen patients treated by Twin-Block and following fixed appliance were included into the TB group. Lateral cephalometric radiographs taken before treatment and immediately after fixed appliance treatment were used to evaluate mandibular growth effects. Results The starting forms of the patients in the two groups were examined to be of good comparability. The mandibular length increased significantly in both groups as measured by Co-Gn, Go-Gn and Ar-Gn, but the TB group didn’t show more mandibular growth than the RME group (P > 0.05). Skeletal changes of the mandible in vertical dimension were different in the two groups. The change in FMA was 0.35° in the RME group, while the change was 2.65° in the TB group (P < 0.001). The change in LAFH was 5.14 mm in the RME group, significantly smaller than the change of 10.19 mm in the TB group (P < 0.001). Conclusion The investigated Phase I treatment with RME followed by Phase II treatment of fixed appliance achieved the same increases in sagittal mandibular growth and facial profile improvements as the Twin-Block therapy. The treatment with RME followed by fixed appliance was better for vertical control, while the treatment with Twin-Block followed by fixed appliance significantly increased the mandibular plane angle.

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