Skeletal Expansion with GSR Expander

This article reports two cases treated with a modified Miniscrew Assisted Rapid Palatal Expander (MARPE) that was fabricated in-office. Two female patients aged 15 years and 18 years were treated for maxillary expansion. An in-office modified GSR Expander was used. The appliance was secured in the patient’s maxillary arch using four miniscrews. Expansion was carried out for 4 weeks and 2 weeks respectively. Considerable opening of mid palatal suture with skeletal expansion was observed. An economical and effective alternative to stock made MARPE with better adaptability and clinical modifiability.

Observational Study Regarding Possible Side Effects of Miniscrew-Assisted Rapid Palatal Expander (MARPE) with or without the Use of Corticopuncture Therapy

The use of maxillary expanders has the effect of distancing the maxillary bones at the level of the median palatal suture. During maxillary expansion, the main resistance forces occur at the zygomatico-maxillary sutures, and not in the median palatal suture, which is the basic principle on which this method is based. In this observational study, we evaluated possible complications at the skeletal and dentoalveolar level after palatal split using miniscrew-assisted rapid palatal expansion (MARPE) associated or not with corticopuncture (CP) therapy. The study included 27 patients with maxillary transverse deficiency and unilateral or bilateral cross-bite. Skeletal and dentoalveolar changes were evaluated using cone beam computed tomography (CBCT) images acquired before and after expansion. The mid-palatal suture was separated in 88.88% of cases, buccal bone height of the alveolar crest had decreased at first molar both at oral and palatal level by approximately 2.07 mm in 40.7% of cases whilst the remaining 59.3% showed insignificant bone loss, with canines exhibiting buccal tipping of 4.10° in 62.5% of cases. Changes of the occlusal planes were observed in 10 cases (37%). Maxillary canines tended to show symmetric buccal inclinations relative to the maxillary basal bone. Six patients; 22.22% showed hypertrophy/hyperplasia of the palatal mucosa associated with ulcerations, erythema, itching, and discomfort in the area. Swelling at the mid-palatal suture after split was observed in all cases and was caused by the resultant force. No cases of necrosis of the palatal mucosa were observed. Although occlusal modifications occur after palatal split, especially in unilateral cross-bite cases, these changes can be treated with the help of fixed orthodontic appliances.

Stress Pattern and Deformation in Mid-palatal Suture and Posterior Dentoalveolar Area With Two Different Types of Rapid Maxillary Expansion Appliances: A Finite Element Method Study

Objective: The study was conducted to evaluate stress pattern and deformation in mid-palatal suture and posterior dentoalveolar area during maxillary expansion therapy with two different types of rapid maxillary expansion by finite element method study. Methods and Methodology: The finite element analysis was performed on a model of maxilla, with narrow maxillary base and teeth digitally reconstructed, based on CBCT images, acquired by child (age 12.5 years) but not in permanent dentition stage from available pool data. Result: More amount of stress was observed in mid-palatal suture and posterior dental alveolar area by using the Hyrax appliance as compared to the Haas appliance. Stress pattern evaluated in mid-palatal suture depicts maximum stress concentration on the anterior region of mid-palatal suture at the position of incisive papilla. Deformation in maximum quantity is observed in central incisors. Maximum stress generation and deformation are observed in lingual region of premolar and molar areas. Minimum stress generation and deformation are observed in the posterior part of last molars. Conclusion: Hyrax produces more stress and deformation in mid-palatal suture as well as in the posterior alveolar segment in comparison to Haas appliance. Better results in the immediate skeletal response were obtained by the Hyrax-type expander as compared to the Haas type.

CBCT and CAD-CAM technology to design a minimally invasive maxillary expander

Background A large number of articles in recent years studying the effects of non-surgically assisted tooth- versus bone-borne maxillary expanders in growing patients have found no significant differences in mid-palatal suture disjunction or even dentoalveolar changes. This suggests the need for new criteria and better use of current technology to make more effective devices and enhance the benefits of conventional treatments. This article describes a titanium grade V computer-aided design/computer-aided manufacturing (CAD/CAM) maxillary expander supported by two miniscrews, along with a 3D printed surgical guide. Methods The first step was to obtain a digitized model of the patient’s upper maxilla. To simplify the process and ensure the placement of the device in a high-quality bone area, the patients’ digital dental cast was superimposed with a cone beam computed tomography (CBCT) scan. Improved resistance to expansion forces was secured through the use of 2 mm-wide miniscrews, long enough for bicortical anchorage. Placement site and direction were assessed individually in order to achieve primary stability. We chose a site between the second premolars and first molars, while the inclination followed the natural contour of the palate vault. A 3D-printed, polyamide surgical guide was designed to ensure the correct placement of the device with a manual straight driver. Results Favorable clinical results were presented with 3D images. We confirmed a mid-palatal suture parallel separation of 3.63 mm, along with a higher palatal volume, as well as increased intercanine and intermolar distance. Segmentation of the facial soft tissue showed an expansion of nasal airways and changes in nasal morphology. Conclusions Digital models, CBCT and CAD/CAM technology, are essential to accomplish the goals proposed in this article. Further studies are necessary to establish safer miniscrew placement sites and insertion angles so as to achieve greater in-treatment stability. Both the clinician and the patient can benefit from the use of current technology, creating new devices and updating traditional orthodontic procedures.

RAPID PALATAL EXPANSION AND ITS FEATURES

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.

Evaluation of Midpalatal Suture Ossification Using Cone-Beam Computed Tomography: A Digital Radiographic Study

Background: Cone beam computed tomography (CBCT) imaging techniques are the recent rage in the field of oral diagnostic imaging modality. It is noninvasive, faster and lacks anatomic superimposition. Earlier maxillary occlusal radiographs were used to assess and evaluate the mid palatal suture, but being a two dimensional imaging modality it could not assess the ossification process which takes place in multiple planes mostly due to curved nature of the palate. In this study we assessed the mid palatal suture morphology and classify them according to the variants using CBCT images. Materials and methods: A total of 200 CBCT scans (95 males and 105 females) were evaluated in the present study from the archives of an imaging center. As per Angelieri classification the midpalatal suture was classified into five categories (A–E) depending on the degree of ossification that had taken place. Statistical analysis was done by Chi Square test using SPSS version 23.0. Results: There is statistically significant difference present in the stages of maturity of mid palatal suture in various age groups with Stage B is most common in Group 1 (50%), Stage C most common in Group 2 (60%) and Group 3 (40%) and Stage E more common in Group 4 (50%). Conclusion: The results of the present study showed a wide variation in the initiation time and the degree of ossification and morphology of the midpalatal suture in different age groups. Although there was an increase in the closure of the suture with aging, age is not a reliable criterion for determining the open or closed nature of the suture. This finding is important in providing an idea as to how diverse is the ossification of maxillary sutures.