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Treatment of Severe Maxillary and Mandibular
ConstrictionSARPE & MSDO
AAO 118th Annual Session
©sylvainchamberland.com
Biography Sylvain Chamberland
•D.M.D. (Docteur en Médecine Dentaire), University Laval, 1983
•Private practice, general dentistry 1983-1988
•Certificate in Orthodontics, University of Montreal, 1990
•M.Sc. in Dental Science, University Laval, 2008
•Private practice in orthodontics since 1990
•Publications
✦Closer look at SARPE, JOMS 2008
✦Short-term and long-term stability of SARPE revisited, AJODO 2011
✦Long-term dental and skeletal changes following SARPE, letter to editor, OOOO 2013
✦Functional genioplasty in growing patients, AO 2015,
✦Response to : Functional geniolasty in growing patients by Chamberland et al, AO 2015,;85, 6: p1083
•Lecturer in several graduate program and scientific meeting in USA, Canada, Europe
©sylvainchamberland.com
Conflict of Interest Declaration
•I declare that neither I nor any member of my family have a financial arrangement or affiliation with any corporate organization offering financial support or grant monies for this continuing education presentation, nor do I have a financial interest in any commercial product(s) or services I will discuss in this presentation
©sylvainchamberland.com
All that is missing is You!
• Introduced in 2009, the DOS program provides access to care for children in need. Access to quality orthodontic care is missing in many children’s lives. The AAO DOS program mission is to serve indigent children without insurance coverage or that do not qualify for other assistance in their state of residence.
• The program has expanded and offers care to children nationwide in addition to the recognized state programs in Illinois, Indiana, Kansas, Michigan, New Jersey, North Carolina, Rhode Island, Tennessee, Texas and Virginia.
• In order to expand further, we need you to help us by volunteering to serve as a provider orthodontist or help identify orthodontists willing to lead efforts to establish a DOS chapter in your state.
• Stop by the DOS booth here in San Diego to learn more about the program or contact Ann Sebaugh at [email protected] with questions.
AAO Donated Orthodontic Services (DOS) Program
©sylvainchamberland.com
Treatment of Severe Maxillary and Mandibular Constriction
• Review of the technique of SARPE and MSDO
• Case reports of combined treatment
• New approach to maxillary expansion
• Conclusion
©sylvainchamberland.com
Mandibular Constriction
Not so constricted Constricted Very constricted
©sylvainchamberland.com
•Skeletal Expansion ★ Mx & Nasal cavity (p < 0.0001)
★ STABLE: NS ∆ (p=0,1166)
•Dental Expansion (7,6± 1,6mm) ★Sig.Relapse: 24% (1,8±1,8mm) at 15
months post SARPE
★Follow up 24m: Relapse 1.1 mm➔ 38% of total expansion
•46% Sk/Dt at 6 m
•65% Sk/Dt at 23,6 m
Changes in the Dental and Skeletal Dimensions Over Time after SARPE
©sylvainchamberland.com
Covariables•Low correlation between skeletal and dental changes: r = .36; r2 = 0.13
• Low correlation between screw changes and skeletal change: r = 0.41; r2 = 0.17
✦ Hemimaxillae do not expand in parallel
✓ Lateral rotation & alveolar bending
• It explains why skeletal expansion is 47% of maximal dental expansion (T3)r T3 r T5Diastema changes / 1st Molar 0.69 0.22Screw changes / 1st Molar 0.93 0.38Screw changes / Skeletal changes 0.41 0.47Skeletal changes / Dental changes 0.36 0.03Expansion / relapse 0.01
©sylvainchamberland.com
•No parallel expansion of hemimaxillae in coronal view
•Rotation of hemimaxillae
✦ Inward movement of alveolar border under the osteotomy cut (C, A)
✦Palatal depth decrease (B)
Before Expansion After ExpansionA
B
CC
Chamberland S, Proffit WR, Short-term and long-term stability of surgically assisted rapid palatal expansion revisited AJODO 2011; 139:815-22Koudstaal MJ, Smeets JB, Kleinrensink GJ, Schulten AJ, van der Wal KG. Relapse and stability of surgically assisted rapid maxillary expansion: an anatomic biomechanical study. J Oral Maxillofac Surg 2009;67:10-4.Chamberland S, Proffit WR. Closer look at the stability of surgically assisted rapid palatal expansion. J Oral Maxillofac Surg 2008;66: 1895-900. Landes CA, Laudemann K, Schubel F, Petruchin O, Mack M, Kopp S, et al. Comparison of tooth- and bone-borne devices in surgically assisted rapid maxillary expansion by three-dimensional computedtomography monitoring: transverse dental and skeletal maxillary expansion, segmental inclination, dental tipping, and vestibular bone resorption. J Craniofac Surg 2009;20:1132-41.Zemann W, Schanbacher M, Feichtinger M, Linecker A, Karcher H. Dentoalveolar changes after surgically assisted maxillary expansion: a three-dimensional evaluation. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009;107:36-42.
©sylvainchamberland.com
•No escape when hemimaxillae are expanded if the cut is not widened at the zygoma
•Obvious inward displacement upon appliance activation per op. This has been proven by Chamberland& Proffit AJODO2011
•As bone contact, resistance may be similar to non-cut bone
©sylvainchamberland.com
How Much Wide?
• 3-4 mm wide
©sylvainchamberland.com
MSDO. Early reports• Tooth anchor expansion device
✦ Force is applied above C/R of Md
• Activation 1 mm /days
• Concerns:
✦ Disproportional widening of the dento-osseous segments (alveolar bone was expanded more than basal bone)
✦ Lower incisor proclinationSanto M., Guerrreo C., Bushang P.H., et al. Long-term skeletal and dental effects of mandibular symphyseal distraction osteogenesis AJODO 2000;118:485-93Santo M., English Jd, Wolford L et al, Midsymphyseal distraction osteogenesis for correcting transverse mandibular discrepancies AJODO 2002; 121: 629-638
©sylvainchamberland.com
Tooth-borne Versus Hybrid Devices for MSDO
• Greater skeletal expansion was achieved with a hybrid distractor.
• Greater dental expansion was achieved with a tooth-borne distractor
• During distraction, the hybrid distractor effected more parallel expansion of basal and alveolar bone than did the tooth-borne distractor
Skeletal and dental effects of tooth-borne versus hybrid devices for mandibular symphyseal distraction osteogenesis, Niculescu, Julia A, John W King, and Steven J Lindauer. Angle Orthod. 2014;84:68–75 doi:10.2319/022213-154.1
©sylvainchamberland.com
Long-Term Skeletal & Dental Stability• Follow-up 6-7 years post distraction
✦ T5-T4 Skeletal change: Stable
✦ T5-T4 Dental change:
✓ NS slight increase 1st molar
King JW, Wallace JC, Winter DL, Niculescu JA. Long-term skeletal and dental stability of mandibular symphyseal distraction osteogenesis with a hybrid distractor. Am J Orthod Dentofacial Orthop 2012;141:60-70.
Durham JN, King JW, Robinson QC, Trojan TM. Long-term skeletodental stability of mandibular symphyseal distraction osteogenesis: Tooth-borne vs hybrid distraction appliances. Angle Orthod 2017;87:246-253.
©sylvainchamberland.com
3e rang EstSt-Gervais ©sylvainchamberland.com
Lessons from the Past• Constricted maxilla
• Significant ALD
• Crossbite #22, #15
• Slight CO/CR discrepancy
• Gingival recession
©sylvainchamberland.com
•Bimax dentoalveolar protrusion
•Retrognathic profile
•No anterior guidance in protrusion
✦ Interferences on balancing side
✦ Bilateral TMJ clicking on opening
✦ Pain on palpation of both lateral pterygoïd
©sylvainchamberland.com
Tx Option
• Non-surgical, extraction of 4 premolars (5’s)
• SARPE + MSDO
©sylvainchamberland.com
Tx Plan
• SARPE and MSDO
May-2001
Mei-Ra May-2001
©sylvainchamberland.com
Follow Up
• Mx: .33 mm/day
• Md: 0,5 mm/day • 3 days into expansion ✓ Sequestra between 31-41 ✓ Granulation tissue B #11
May 28
✓ 7 days post surgeryMay 25 June 6
✓ 21 days post surgery
©sylvainchamberland.com
End of Distraction
• Expansion is slightly larger at the dental level than the mandibular border
June 11
©sylvainchamberland.com
At 4 months• Mx: .016 CNT
• Md: segment .016 CNT
• At 5 months ✦ Removal of both expander, bond molars ✦ Lower arch aligned in 3 segments
©sylvainchamberland.com
At 10 Months• Mx & Md: .016 X .022 cnt
★Elastomeric chain 42 to 32
★2nd molars were not engaged
March 02©sylvainchamberland.com
Parodontal Assessment• Root surfacing was
required
April 2002
©sylvainchamberland.com
Outcome• Class I occlusion was achieved
• Slight anterior guidance
• Slight curve of Spee maintained
• Gingival recession B 31-41
©sylvainchamberland.com
Dental Changes
• At 1st molars
✦ Mx: + 4,06
✦ Md: + 6,58
43.48
50.06+6.58
38.15
42.21+4.06
©sylvainchamberland.com
Tx time: 22 months
• No TMJ symptoms
• Maximum interincisor opening 46 mm
©sylvainchamberland.com
Superposition
• Md forward??
• /1-MP = maintained
• 1/-FH increased
©sylvainchamberland.com
RM 24
• Parodontal status maintained or improved
• Root parallelism improved, except 21 & 22
©sylvainchamberland.com
Follow up at 31 months
©sylvainchamberland.com
Epilogue• I said that I will never do that again…
• But…
✦ Bone anchor device:
✓ Malkoç et al Sem. Ortho. 2012; 18:152-161 et AJODO 2007; 132:769-75
✓ Conley RS., Legan HL AJODO 2006; 129:283-92
©sylvainchamberland.com
Missed Opportunity
©sylvainchamberland.com
3e rang EstSt-Gervais ©sylvainchamberland.com
Bologna Midline Distractor (KLS Martin)
• 1 activation 90° = 0,25 mm
• Screw parallel to occlusal plane
• Relief 2 mm buccal
• Upper connector 2-3 mm apical to gingival margin
©sylvainchamberland.com
• Fissure bur
• Osteotomy cut deviated to the right where there is more room between roots of 42-43.
©sylvainchamberland.com
• q
Inferior plates of the distractor are bent and adjusted to the form of the mandible
Distractor seated on abutment teeth to figure out plates adjustment
Stepped parasagittal cut to widest interradicular site
Bologna Distractor
Precise plates positioning to ensure stress-free fixation
©sylvainchamberland.com
Osteotomy sitePrecise plates positioning to ensure stress-free fixation
Precise adaptation & fixation Mobility check of bone fragment©sylvainchamberland.com
Precise adaptation & fixation Mobility check of bone fragment
Mucosa margin sutured2 mm expansion perop
©Dr Sylvain Chamberland
• EMRAC movie
©sylvainchamberland.com
Distraction Protocol•Latency period of 7-8 days
✦Critical to allow time for a callus of good quality to form
•Rate of distraction: 1 mm per day
✦ Too fast: can lead to poor bone quality, partial union, fibrous union
✦ Too slow: premature consolidation, inability to obtain the planned amount of expansion
•Rhythm of distraction: 0,25 mm qid or 0,50 mm bidConley R., Legan H., Mandibular Symphyseal Distraction Osteogenesis:Diagnosis and Treatment Planning Considerations, Angle Orthod 2003;73:3–11
©sylvainchamberland.com
Distraction protocol• Postdistraction orthodontic movement
✦ Should not begin until radiographic evidence of consolidation is observed
✦ Typically 2-3 months
• Removal of the distractor
✦ 6 months after the end of distraction
Conley R., Legan H., Mandibular Symphyseal Distraction Osteogenesis:Diagnosis and Treatment Planning Considerations, Angle Orthod 2003;73:3–11 ©sylvainchamberland.com
Complications• Irritation to labial mucosa
• Gingival inflammation
✦ Careful cleaning is mandatory
• Loss of interdental septum
✦ Mesial to 31Garreau É, Wojcik T, Rakotomalala H, Raoul G, Ferri J. Symphyseal distraction in the context of orthodontic treatment: A series of 35 cases, Int Orthod. 2015 Mar;13(1):81-95.
©sylvainchamberland.com
Complications• Cellulitis
✦1 patient required antibiotic therapy + marsupialisation
• Hardware problems:
✦ If the surgeon break the thread of the screw or forget to ligate, your are screwed…
Garreau É, Wojcik T, Rakotomalala H, Raoul G, Ferri J. Symphyseal distraction in the context of orthodontic treatment: A series of 35 cases, Int Orthod. 2015 Mar;13(1):81-95.
1 m post distraction 5 days later
©sylvainchamberland.comRte 279 intersection 3e rang Est, St-Gervais-St Lazare
©sylvainchamberland.com
Case 2• Class I
• Constricted dental arches
• Moderate ALD
FrDeMa020412©sylvainchamberland.com
• Orthognathic profile
• But slight retrusion of Mx & Md
• Mouth breatherFrDeMa020412
©sylvainchamberland.com
End of distraction•Mx: 0,25 mm bid
✦mx diastema: 8,6 mm
•Md: 0,5 mm bid (2 activations bid or 2 activations morning 1 activation evening)
✦0,75 to 1 mm per day
✦∆ intercanine= 5,4 mm, diastema ~ 6 mm
De-Ma, Fri 23-05-2013
©sylvainchamberland.com
1 m Postdistraction
• Latency period was 7 days. Expansion monitored every week
• Activation period: 14 days
• Note the parallelism of md segment
De-Ma, Fri 23-05-2013
©sylvainchamberland.com
• Bonding at 1 month post distraction
✦ Mx: .016 Supercable™ 15 to 25
✦ Md: .016 Supercable™ 42 to 33
• Careful cleaning and root surfacing at each visit
De-Ma, Fri 20-06-2013 De-Ma, Fri 05-08-2013
©sylvainchamberland.com
• At 20 weeks
✦ Mx: .016 x .022 CNT
✦ Md: .016 CNT
De-Ma, Fri 16-09-2013
©sylvainchamberland.com
• At 32 weeks
✦ Mx expansion device is removed
✦ Mx and Md arch are coordinated; .020x .020CNT / .016 X .022CNT
✦ Class I relationship is maintained
✦ Crowding is resolved
De-Ma, Fri 09-12-2013
©sylvainchamberland.com
• Transverse dimension improved
• 1st, 2nd & 3rd order movement needed for lower and upper anteriors
FrDeMa020412 De-MaFr09-12-2013FrDeMa200613 De-MaFr06-03-2014De-MaFr27-05-2014
©sylvainchamberland.com
At 76 weeks• Finishing stages
De-MaFr16-10-2014
©sylvainchamberland.com
Final outcome• Tx time 85 weeks
• Class I fonctionnal occlusion
FrDeMa161214
©sylvainchamberland.com
• Improvement of interincisal relationship
✦ 1/ retroclined 10°, /1 maintained 93°
• Profil maintained or improved
©Dr Sylvain Chamberland
• Osteogenesis of distraction site
• Root surfacing was done mesial of #43 during tx.
• Root parallelism obtained (except 34)
FDM_Jan-28-2014
©Dr Sylvain Chamberland
Dental Changes
33,77
25,47
30,43
24,51
24,34
42,44
32,99+7,52
+8,67
+8,72
+10,02
+2,24
39,15
34,53
26,58+23,62+21,56 ©sylvainchamberland.com
Follow up at 2 years
De-MaFr12-01-2017
©sylvainchamberland.com
3e rang EstSt-Gervais ©sylvainchamberland.com
Risk and Complication• Case from a netsurfer who lives
in France
• Oronasal communication
• Open communication mesial to #31
• This case is…POORLY manage
©sylvainchamberland.com
Risk and Complication• Follow up ~ 1 year
• Lack of bone between central incisors
• Hyperplasia right concha
©sylvainchamberland.com
Risk and Complication
• Follow up
✦ 16 months post MSDO + SARPE
• Bone graft has failed
• Redo is planned…
©sylvainchamberland.com ©sylvainchamberland.com
Mx & Md Constriction
End of SARPE End of MSDOMidline osteotomy cut is where there is space available
Courtesy of Dr Dany Morais & Dr Claude Gariepy
©sylvainchamberland.com
Outcome
• Final occlusion
Prior phase 2 surgery
Courtesy of Dr Dany Morais & Dr Claude Gariepy
©sylvainchamberland.com
•Class I
•Severe bimax constriction
Courtesy of Dr Sandra Labbé
JeDu Aprl 2017
JeDu Aprl 2017
©sylvainchamberland.com
JeDu Aprl 2017
JeDu January 2018
Courtesy of Dr Sandra Labbé
©sylvainchamberland.com
End of Distraction
• Inward rotation of hemimaxilla
• Parallel md expansion
✦ Expansion device || occlusal plane
Courtesy of Dr Sandra Labbé
JeDu 23 octobre 2017
©sylvainchamberland.comRang St-Joseph, Armagh, Bellechasse ©sylvainchamberland.com
• Class I
• Missing 42, 41
• Maxillary and mandibular constriction
• ENT specialist referred for snoring and apnea
NiBo040614
©sylvainchamberland.com
• Mx et Md Retrusion
• Class I skeletal relationship
• Proclined 1/ (121°)
• Retroclined /1 (79°)
©sylvainchamberland.com
• Similar case published by Conley et Legan
Conley RS., Legan HL., Correction of severe obstructive sleep apnea with bimaxillary transverse distraction osteogenesis and maxillomandibular advancement. AJODO 2006;129:283-92
©sylvainchamberland.com
•Osteotomy on the midline turning to the right between diverging roots of 43 - 31.
•Problems
✦ Complete separation should not be done before fixation of the distractor
✦ Distraction device should be more parallel to the occlusal plane
✦ Fitting of the plates could be improved
©sylvainchamberland.com
• Distraction starts 7 days post op
• Mx: activation ⅓ mm bid
• Md: 2 activations morning (0,5 mm) et 1 activation evening (0,25 mm)
NiBo230914
©sylvainchamberland.com
End of Distraction at 30 days post op
NiBo161014
• Distractor canted to the left
©Dr Sylvain Chamberland
NiBo021014
Oct. 2 (+10 days) c-c = 15 mm
NiBo091014
Oct. 9 (+7 days) c-c = 16,7 mm
NiBo141014
Oct.14 (+5 days) c-c = 20,5 mm
NiBo161014
Oct 16 (+2 days) c-c = 22,5 mm
Latérodéviation mandibulaire gauche.
©sylvainchamberland.com
Complication
Oct. 16 Nov. 12 Nov. 17Patient noted that the screw seems to unscrew
Nov. 24: reactivation completed + ligature Dec.17: Bond Mx teeth
11,5 mm
10,4 mm10,8 mm
©sylvainchamberland.com
•Note
✦Chances are that thread of the screw were stripped when the surgeon adapted the plates of the device on the symphysis and it may explain the loss of expansion at 1 month post distraction, because there was some slack of the screw when activating.
✦Or it is because the screw was not ligate and immobilized at the end of distraction.
✦Advice: Always lock the screw with a ligature with such device.
17,5 mm
39,62 mm
©sylvainchamberland.com
• I accepted the loss of 1 to 2 mm expansion
• Because I had to reactivate 1 month after we had stopped distraction I was nervous to reactivate .
NiBo161014
NiBo171214
End of Distraction. October End of Distraction. December
©sylvainchamberland.com
What Happen You Don’t Ligate the Screw?
• You will likely learn the hard way that you should have ligate…
• Complete relapse in 2 months
• Call
JeDu January15 2018
JeDu 23 octobre 2017
JeDu March 12, 2018
©sylvainchamberland.com
19 weeks• Osteogenesis at
distraction site
• Bonding md teeth
NiBo260115 ©sylvainchamberland.com
At 5½ months• Wide BL width of the
distraction site
NiBo090315
©sylvainchamberland.com
At 7 Months • Removal Mx distractor Superscrew™
NiBo220415©sylvainchamberland.com
At 8 Months• Removal of the
Bologna Distractor
• Possible sequela of reactivation at 1 months
NiBo280515
©sylvainchamberland.com
Bone Grafting• Follow up 2 months post grafting
NiBo241115
©sylvainchamberland.com
•Baseline June 2014 on left
•Progress January 2016→ 12,42
17,66
33,69
40,17
24,83
25,2 33,54
34,84
48,22
42
32,7824,32
10,52
+8,34
+10,01
+8,05
+8,31
+15,12+11,9
©sylvainchamberland.com
69 weeks
NiBo12012016©sylvainchamberland.com
Mx width 59,6 Mx width 65,5 +5,9 mm
©sylvainchamberland.com
82 weeks
• Implant placement with a surgical guide
©sylvainchamberland.com
94 weeks
NiBo07072016
©sylvainchamberland.com
94 weeks
©sylvainchamberland.com
Follow up 61 weeks into retention
NiBo05092017
©sylvainchamberland.com
Follow up 61 weeks into retention
• Good osteogenesis
• Increase oropharynx airway
NiBo05092017NiBo05092017
©sylvainchamberland.com
Airways• Oropharynx
widened
• Hyoïd bone moved up
• Epiglottis opened
©sylvainchamberland.com
Orthodontic Pearls Controversies
• Such outcome CAN NOT be compare to bone augmentation completed with corticotomy and grafted freeze-dried bone allograft material
• SARPE or MARPE and MSDO is by far better IMHO
©sylvainchamberland.com
Corticotomy & Grafted Freeze Dried Bone
• Mx dentoalveolar expansion
• Md dentoalveolar expansioninto grafted bone
• Increase airway (?????)
✦ Buccal proclination
✦ Md forward position
• NO BASAL WIDTH CHANGEEvans M. et al, 3D guided comprehensive approach to mucogingival problems in orthodontics , Semin Orthod 2016;22:52– 63.
What is New About Maxillary Expansion?
New Hybrid Superscrew Device MARPE
3e rang EstSt-Gervais ©sylvainchamberland.com
What is New About Maxillary Expansion?
• Hy
Tooth-Borne device+ Le Fort 1 osteotomy
Hybrid device+ Le Fort 1 osteotomy
Bicortical TAD Non Surgical
Maxillary Skeletal Expansion
©sylvainchamberland.com
• Parallel expansion of buccal segment
✦ Note the step out at the osteotomy cut
• Mx width gain 8,6 mm
• Nasal cavity width gain 6,6 mm
Lar-Lav Ste-10-12-15Lar-Lav Ste-10-12-15
©sylvainchamberland.com
•Larger skeletal expansion
©sylvainchamberland.com
Hybrid Hyrax•Early cases
✦ TADs too short (8 mm)
✦ 10-12 mm recommended to engage both palatal & nasal cortex
•TADs should be place in the horizontal part of the palate
•Expansion device in line or posterior to 1st molars
DubPe30-09-15
Tomas pin EP 12 mm
©sylvainchamberland.com
Miniscrew Assisted Rapid Palatal Expansion (MARPE)
•4 mini-screw de 1,8mm X 11 mm
•MSE position: posterior palatal vault between 1st-2nd molars
•Rate of activation MSE II
✦Early teens: 6x/week (0,8 mm/Wk)
✦Teens: 2x/day (0,27 mm/ day)
✦Early to mid 20s: 4-6x/day (0,53-0,8 mm)
✦Adult (>25-30): 4-6X/day minimum
•After diastema: 2x/day (0,27 mm/day)
•Non rigid connector •Dégagement 2 mm
©sylvainchamberland.com
MARPE• Disengagement of pterygoïd plate /
pyramidal process
✦ 53% (16 sutures/30)
• Skeletal expansion
✦ 71% et 63% of the screw changes
✓ (SARPE: 46%)
71%
63%
A:Rupture bilatérale. B: Rupture unilatérale
• Cantarella D, Dominguez-Mompell R, Mallya SM, Moschik C, Pan HC, Miller J et al. Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging. Prog Orthod 2017;18:34. ©sylvainchamberland.com
MARPE Skelettal Changes vs SARPE•MARPE Center of Rotation higher than SARPE
•MARPE
✦ Maxilla move laterally
✓ Downward
✓ Forward
✦ Hemimaxillae: quasi parallel expansion
✓ Posterior part bend medially• Cantarella D, Dominguez-Mompell R, Mallya SM, Moschik C, Pan HC, Miller J et al. Changes
in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging. Prog Orthod 2017;18:34.
✦ as a consequence of the rotation
as a consequenceof the rotation}
After Expansion
B
CR CR
SARPE
©sylvainchamberland.com
Dental Expansion
13,8 mm
38,3 45,7+7,4 45,3+7
©sylvainchamberland.com
Skelettal Expansion
•Mx: 5,7 mm •NC: 5,3 mm •1stM: 7 mm
•Sk/Dt : 81%
©sylvainchamberland.com ©sylvainchamberland.com
Conclusion• Mandibular symphyseal distraction osteogenesis
✦ Effective to alleviate md crowding and maintain /1 AP relationship
✦ Small advancement of the mandible could be explained by outward rotation of the condyle in the fossa
✦ May improve airways by permitting the tongue to have room between dental arches
• Monitoring expansion every week is mandatory. Every 3-4 days ideally
©sylvainchamberland.com
Conclusion• SARPE:
✦ Skeletal change is stable but account for only 46% at end of distraction
• MARPE
✦ Skeletal change is about 70% of the screw change
• MSDO
✦ Skeletal change is about 80% of the screw change. Relapse is NS
• Therefore one should aim for skeletal change because it is stable
©sylvainchamberland.com
MSE & MSDO
• Correct the Mx expansion with MSE device or Hybrid device
• Mandibular Symphyseal Distraction Osteogenesis
Bicortical TAD MARPE
De-Ma, Fri 23-05-2013
Hybrid Supercrew
Thank youDo you have questions?
2e Rang St-Gervais, Bellechasse