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Rapid Maxillary Expansion : An Update

This presentation provides an overview of contemporary research on Rapid Maxillary Expansion technique.

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Rapid Maxillary Expansion : An Update

  1. 1. Rapid Maxillary Expansion : An Update Nalaka Jayaratne BDS, PhD Resident in Orthodontics, University of Connecticut School of Dental Medicine USA
  2. 2. History • First used in 1860 • By Emerson C. Angell (1822-1903)
  3. 3. History • Walter Coffin – 1877
  4. 4. History • Walter Coffin – 1877 • Not accepted by ortho community
  5. 5. History • Walter Coffin – 1877 • Not accepted by ortho community • Reintroduced in 1950’s by Korkaus and Andrew Hass
  6. 6. Indications for RME • Posterior crossbites • Class III malocclusions • Cleft palate patients with collapsed maxillary arch • Adjunct to facemask therapy
  7. 7. Types of RME Appliances Removable Fixed Tooth borne lsaacson type Hyrax type Tooth and tissue borne Derichsweiler type Hass type
  8. 8. Tooth borne lsaacson type Hyrax type
  9. 9. Tooth borne lsaacson type Hyrax type Spring loaded screw- Minne Expander
  10. 10. Tooth borne lsaacson type Hyrax type Spring loaded screw- Minne Expander
  11. 11. Tooth and tissue borne Derichsweiler type Hass type Image Source: Bhalajhi SI. Orthodontics: At The Art and Science (5th Ed)
  12. 12. Tooth and tissue borne Derichsweiler type Hass type Wire tags Image Source: Bhalajhi SI. Orthodontics: At The Art and Science (5th Ed)
  13. 13. Tooth and tissue borne Derichsweiler type Hass type Wire tags Image Source: Bhalajhi SI. Orthodontics: At The Art and Science (5th Ed)
  14. 14. Tooth and tissue borne Derichsweiler type Hass type Wire tags Thick SS wire - 1.2mm Image Source: Bhalajhi SI. Orthodontics: At The Art and Science (5th Ed)
  15. 15. RAPID MAXILLARY EXPANSION 1. What are the effects of RME on facial sutures and bone? 2. How do RME affect the airway? 3. What are the dental changes caused by RME?
  16. 16. RAPID MAXILLARY EXPANSION 1. What are the effects of RME on facial sutures and bone? 2. How do RME affect the airway? 3. What are the dental changes caused by RME?
  17. 17. Inclusion criteria • Quantitative data on the immediate effect of RME assessed by CBCT or CT Exclusion criteria • Surgical treatment and/or surgery in combination with RME • Papers on syndromic or medically compromised patients Final article count: 10
  18. 18. Midpalatal Suture Image Source: Bhalajhi SI. Orthodontics: At The Art and Science (3rd Ed)
  19. 19. Midpalatal Suture • Triangular – 3 studies • Parallel - 1 study • Largely anteriorly in some individuals and largely posteriorly in others – 1 study Image Source: Bhalajhi SI. Orthodontics: At The Art and Science (3rd Ed)
  20. 20. Mid-palatal suture: Mean expansion
  21. 21. Mid-palatal suture: Mean expansion Posterior region
  22. 22. Mid-palatal suture: Mean expansion Posterior region = 1.6 -4.33 mm
  23. 23. Mid-palatal suture: Mean expansion Posterior region = 1.6 -4.33 mm = 22%–53% screw expansion
  24. 24. Mid-palatal suture: Mean expansion Posterior region = 1.6 -4.33 mm = 22%–53% screw expansion Anterior region
  25. 25. Mid-palatal suture: Mean expansion Posterior region = 1.6 -4.33 mm = 22%–53% screw expansion Anterior region = 1.52 to 4.33 mm
  26. 26. Mid-palatal suture: Mean expansion Posterior region = 1.6 -4.33 mm = 22%–53% screw expansion Anterior region = 1.52 to 4.33 mm = 20%–53% screw expansion
  27. 27. Mid-palatal suture: Mean expansion Posterior region = 1.6 -4.33 mm = 22%–53% screw expansion Anterior region = 1.52 to 4.33 mm = 20%–53% screw expansion Mid-palatal suture opening = 20%–50% screw opening
  28. 28. Dentoalveolar Expansion • Transverse dentoalveolar expansion>skeletal expansion
  29. 29. Dentoalveolar Expansion • Transverse dentoalveolar expansion>skeletal expansion • Alveolar bending30% of the total expansion
  30. 30. Dentoalveolar Expansion • Transverse dentoalveolar expansion>skeletal expansion • Alveolar bending30% of the total expansion • Mean buccal tipping of the first molars ~ 7.50 Image Source: Bhalajhi SI. Orthodontics: At The Art and Science (5th Ed)
  31. 31. Profitt’s View Image Source: Profitt WR. Contemporary Orthodontics (5th Ed)
  32. 32. Profitt’s View Teeth cannot respond suture is opened
  33. 33. • 20 patients (12.3 ± 1.9 years)
  34. 34. • 20 patients (12.3 ± 1.9 years) • RME until the required amount of expansion was achieved and the palatal cusp of the maxillary first molar contacted the buccal cusp of the mandibular first molar
  35. 35. • 20 patients (12.3 ± 1.9 years) • RME until the required amount of expansion was achieved and the palatal cusp of the maxillary first molar contacted the buccal cusp of the mandibular first molar • Spiral CT scans  Pre-RME (T1)  Post-RME (T2)- immediately after the hyrax was removed (3 months)
  36. 36. What is the Center of Rotation during RME?
  37. 37. Frontomaxillary suture
  38. 38. Frontomaxillary suture
  39. 39. Frontomaxillary suture
  40. 40. Internasal suture
  41. 41. Midpalatal Suture
  42. 42. Results Greatest increase in width
  43. 43. Results Greatest increase in width  Intermaxillary suture (1.7 ± 0.9 mm)
  44. 44. Results Greatest increase in width  Intermaxillary suture (1.7 ± 0.9 mm)  Internasal suture (0.6 ± 0.3 mm)
  45. 45. Results Greatest increase in width  Intermaxillary suture (1.7 ± 0.9 mm)  Internasal suture (0.6 ± 0.3 mm)  Maxillonasal suture (0.4 ± 0.2 mm)
  46. 46. Results Greatest increase in width  Intermaxillary suture (1.7 ± 0.9 mm)  Internasal suture (0.6 ± 0.3 mm)  Maxillonasal suture (0.4 ± 0.2 mm) Midpalatal suture  At central incisor (1.6 ± 0.8 mm)  At canine level (1.5 ± 0.8 mm)  at first molar level (1.2 ± 0.6 mm)
  47. 47. Results Greatest increase in width  Intermaxillary suture (1.7 ± 0.9 mm)  Internasal suture (0.6 ± 0.3 mm)  Maxillonasal suture (0.4 ± 0.2 mm) Midpalatal suture  At central incisor (1.6 ± 0.8 mm)  At canine level (1.5 ± 0.8 mm)  at first molar level (1.2 ± 0.6 mm)  No significant expansion of frontozygomatic, zygomaticomaxillary, zygomaticotemporal, and pterygomaxillary sutures
  48. 48. Conclusions • RME forces primarily affect the anterior sutures (intermaxillary and maxillary frontal nasal interfaces) compared with the posterior (zygomatic interface) craniofacial structures
  49. 49. Conclusions • RME forces primarily affect the anterior sutures (intermaxillary and maxillary frontal nasal interfaces) compared with the posterior (zygomatic interface) craniofacial structures • Cranial sutures respond differently to the external orthopedic forces according to their anatomic location and the degree of interdigitation
  50. 50. Conclusions • RME forces primarily affect the anterior sutures (intermaxillary and maxillary frontal nasal interfaces) compared with the posterior (zygomatic interface) craniofacial structures • Cranial sutures respond differently to the external orthopedic forces according to their anatomic location and the degree of interdigitation • Lack of significant opening of other craniofacial sutures supports clinical findings of reduced effectiveness of maxillary expansion and protraction facemasks in adolescents
  51. 51. Effect on orbits
  52. 52. Effect on orbits
  53. 53. Effect on orbits
  54. 54. RAPID MAXILLARY EXPANSION 1. What are the effects of RME on facial sutures and bone? 2. How does RME affect the airway? 3. What are the dental changes caused by RME?
  55. 55. RAPID MAXILLARY EXPANSION 1. What are the effects of RME on facial sutures and bone? 2.How does RME affect the airway? 3. What are the dental changes caused by RME?
  56. 56. Airway Measuring Devices Rhinomanometry Acoustic Rhinometry
  57. 57. Airway Measuring Devices Rhinomanometry Acoustic Rhinometry
  58. 58. RAPID MAXILLARY EXPANSION 1. What are the effects of RME on facial sutures and bone? 2. How does RME affect the airway? 3. What are the dental changes caused by RME?
  59. 59. RAPID MAXILLARY EXPANSION 1. What are the effects of RME on facial sutures and bone? 2. How does RME affect the airway? 3.What are the dental changes caused by RME?
  60. 60. Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AmJ Orthod Dentofacial Orthop 1994;106:322-328. Buccal tipping of upper molars & premolars Palatal cusp move downwards Premature contact with lower teeth Clockwise rotation of mandible Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AJODO 1994;106:322-328. Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AmJ Orthod Dentofacial Orthop 1994;106:322-328. Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AmJ Orthod Dentofacial Orthop 1994;106:322-328.
  61. 61. Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AmJ Orthod Dentofacial Orthop 1994;106:322-328. Buccal tipping of upper molars & premolars Palatal cusp move downwards Premature contact with lower teeth Clockwise rotation of mandible Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AJODO 1994;106:322-328. Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AmJ Orthod Dentofacial Orthop 1994;106:322-328.
  62. 62. Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AmJ Orthod Dentofacial Orthop 1994;106:322-328. Buccal tipping of upper molars & premolars Palatal cusp move downwards Premature contact with lower teeth Clockwise rotation of mandible Majourau A, Nanda R. Biomechanical basis of vertical dimensional control during rapid palatal expansion therapy. AJODO 1994;106:322-328.
  63. 63. Buccal tipping of upper molars & premolars Palatal cusp move downwards Premature contact with lower teeth Clockwise rotation of mandible Image Source: Nanda RS, Tosun Y. Biomechanics in Orthodontics: Principles and Practice
  64. 64. Take-home messages
  65. 65. Take-home messages • Mid palatal suture opening is commonly triangular but it can be parallel
  66. 66. Take-home messages • Mid palatal suture opening is commonly triangular but it can be parallel • Mid-palatal suture opening = 20%–50% screw opening
  67. 67. Take-home messages • Mid palatal suture opening is commonly triangular but it can be parallel • Mid-palatal suture opening = 20%–50% screw opening • RME primarily affect the anterior sutures than posterior sutures
  68. 68. Take-home messages • Mid palatal suture opening is commonly triangular but it can be parallel • Mid-palatal suture opening = 20%–50% screw opening • RME primarily affect the anterior sutures than posterior sutures • RME can improve nasal breathing
  69. 69. Take-home messages • Mid palatal suture opening is commonly triangular but it can be parallel • Mid-palatal suture opening = 20%–50% screw opening • RME primarily affect the anterior sutures than posterior sutures • RME can improve nasal breathing • Vertical changes due to RME are small and transient
  70. 70. Thank You

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