Retrospective Case Series Regarding the Advantages of Cortico-Puncture (CP) Therapy in Association with Micro-Implant Assisted Rapid Palatal Expander (MARPE)

Transverse maxillary deficiency currently affects 8–23% of adults. One of the most widely used orthodontic treatments today in patients with transverse maxillary defects is the maxillary skeletal expander (MSE). This was a retrospective observational imaging study regarding structural bone changes that may occur during healing after the placement of micro-implant assisted rapid palatal expanders (MARPE) in combination with cortico-puncture (CP) therapy. Regarding the magnitude of the mid-palatal suture opening, the mean split at the anterior nasal spine (ANS) and the posterior nasal spine (PNS) was 3.76 and 3.12 mm, respectively. The amount of split at the PNS was smaller than at the ANS, approximately 85% of the distance, showing that the opening of the midpalatal suture was almost parallel in the sagittal plane. On average, one-half of the anterior nasal spine (ANS) moved more than the contralateral by 0.89 mm. In the present study, we show that MARPE associated with CP therapy had a positive outcome on the midpalatal suture opening. This occurred in safe conditions, without post-surgery bleeding, and showing healing at the corticotomy level, with no signs of swelling or sepsis, which are side effects usually associated with more complex surgical treatments. Our results suggest that non-surgical palatal expansion, assisted by MARPE and CP, is achievable and predictable in young adults.

Premaxilla: up to which age it remains separated from the maxilla by a suture, how often it occurs in children and adults, and possible clinical and therapeutic implications: Study of 1,138 human skulls

ABSTRACT Objective: To evaluate topographic and temporal aspects of premaxillary bone and premaxillary-maxillary suture, since they are fundamental anatomical elements little explored clinically. Methods: 1,138 human dry skulls were evaluated, of which 116 (10.19%) of the specimens were children, and 1,022 (89.81%) were adults. The skulls were photographed and the percentage of premaxillary-maxillary suture opening was determined. Subsequently the data were tabulated and submitted to statistical analysis, adopting a level of significance of 5%. Results: The progression of premaxillary suture closure from birth to 12 years of age was 3.72% per year. In 100% of the skulls up to 12 years, the premaxillary-maxillary suture open in the palatal region was observed, while 6.16% of adults presented different degrees of opening. Conclusions: The premaxilla exists in an independent way within the maxillary complex and the presence of the premaxilla-maxillary suture justifies the success of anteroposterior expansions to stimulate the growth of the middle third of the face, solving anatomical and functional problems.

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.

Niğde Altunhisar Yöresi Bademlerinin Seleksiyonu

This study was to carried out to determine of promosing almond genotypes in Altunhisar county of Niğde province in 2013. 280 genotypes in terms of nut size, suture opening of the shell, shell thickness, softness of the shell, kernel color intensity, shriveling of kernel, kernel pubescence, kernel taste, percentage of double kernel, percentage of sound kernel, nut weight, shell thickness, nut length, nut width, nut thickness, nut shape, marking of outer shell, shell color, kernel weight, kernel length, kernel width, kernel thickness, kernel ratio, kernel size, percentages of twin kernels, width indice and thickness indice were examined. The genotyips had more than 0.70 g kernel weight and %25 kernel rate were taken for evaluation, Total Weight-Ranked Points were calculated with considering genotype quality situations. Nut size, suture opening of the shell, softness of the shell, kernel color, shriveling of kernel, kernel pubescence, kernel taste, percentage of double kernel, percentage of sound kernel etc. characters were used. 15 genotypes (98, 160, 196, 187, 162, 191, 282, 168, 176, 261, 213, 6, 112, 147, 241 ) taken highest points were selected as promosing genotypes. Selected genotypes had 2.37 (no 187) – 3.80 (no 241) g nut weight; 0.71 (no 187) – 1.0 (no 241) g kernel weight; %25.17 (no 162) - 29.97 (no 6) kernel ratio; 1.96 (no 282) – 3.29 (no 162) mm shell thickness; %0.00 – 19.00 percentage of double kernel; %0.00 – 5.00 percentage of twin kernel. It was found that in terms of softness of the shell,15 genotype was very hard; in terms of kernel weight, 14 genotypes were small and 1 genotype was medium; in terms of kernel taste, 12 genotypes were sweet and 3 genotypes were intermediate; in terms of kernel pubescence, 6 genotypes were intermediate, 9 genotypes were low; in terms of color intensity, 8 genotypes were intermediate light and 1 genotype was light and 6 genotypes were dark. In the begining of vegetation in 2014, in promosing genotypes, phenological observations will be taken and in the end of the second year of the research, superior genotypes will be determined.

Opening of Circumaxillary Sutures by Alternate Rapid Maxillary Expansions and Constrictions

Objective: To analyze quantitatively the circumaxillary suture opening after alternate rapid maxillary expansions and constrictions (Alt-RAMEC). Materials and Methods: Twelve inbred cats were randomly grouped into two equal groups for 1 week of rapid maxillary expansion (RME) (1 mm/day) or 5 weeks of Alt-RAMEC (1 mm/day). At the end of the experiment, the craniofacial skeleton of each cat was harvested. Each circumaxillary suture was then probed at three sites with a 0.5-mm pointed periodontal probe. A smooth probing without penetration was an ineffective suture opening (<0.5 mm), while a probing with penetration was an effective suture opening (>0.5 mm). For each suture, the quantity of suture opening (%) was the effective suture opening/(effective + ineffective suture opening). The intergroup differences were analyzed by chi-square test (P < .05). Results: Five weeks of Alt-RAMEC opened the circumaxillary sutures significantly more than 1 week of RME. This affected the circumaxillary sutures running coronally and articulating directly to the maxilla (56.9% vs 36.1%, P < .001), the sutures running sagittally, but articulating indirectly to the maxilla (94.4% vs 64.8%, P < .001), and the sutures running coronally, but articulating indirectly to the maxilla (58.3% vs 33.3%, P < .01). The sutures running sagittally were opened significantly more (94.4%–100.0%) than those running coronally (56.9%–58.3%), no matter if they articulated directly or indirectly with the maxilla. Conclusions: Alt-RAMEC opens both the sagittally and coronally running circumaxillary sutures quantitatively more than conventional RME. However, more than 5 weeks of Alt-RAMEC would be needed to increase the opening of the coronally running circumaxillary sutures. (Angle Orthod. 2009:79; )

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

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.