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Dr. N.R. Krishnaswamy M.D.S, Morth. RCS[Ed],

Dip.NB(ortho)

Diplomate of the Indian Board of Orthodontics,

Prof. & Head Dept. of OrthodonticsRAGAS DENTAL COLLEGE AND HOSPITAL, CHENNAI, INDIA.

Facts and Fallacies

Non Surgical Maxillary Expansion in Adults

ennarmd3@yahoo.com

• Non -carious cervical wear - Abfraction

• Gingival wear

• Functional shift-TMD

• Low Masticatory ability index

• Reduced Food Intake Ability

• Negative buccal corridor

• To facilitate surgical correction of Mandibular retrusion and

prognathism

Rationale for Transverse Correction – Adults

High principle stress value

Places the bone remodeling in the “pathologic overload window

Bone resorption –not coupled to formation

Causes an overload on the implants and implant loosening

Monocortical anchorage

Failure of deformation and fracture in bone borne expansion are more likely to occur with monocortical anchorage

considered for clinical situations requiring Heavy anchorage

Lower stress at the peri implant site in the bi-cortical models compared with mono-cortical models suggests that mini implants placed bi-cortically decreases the risk of mini implant loosening.

Bi-cortical anchorage supported expansion leads to increased expansion compared with the mono-cortical anchorage.• More parallel expansion • Improves stability• Increased amount of expansion in the posterior region

Bi-cortical anchorage

Normal PT Values

J-J 73 69.8 mm

AG-AG 92.5 83.1

Maxillo-mandibular relation 19.5 13.3

Differential 6.2

43.56 mm

46.29 mm

45.20 mm

49.02 mm

YTICres -2.73mm ( -0.398 ± 1.87mm)

Dental width IMW 3.82mm (8.43 ± 2.22mm)

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Prior to expansionPOST-Expansion

After 21 days of activation PRE-Expansion POST-Expansion

Intermolar width

Alveolar width

Suture Opening

DENTAL

EXPANSION

5.73(19%) 8.5(54%)

Canine 1 1.2

I pre-molar 0.8 3

II pre-molar 1.1 1.3

Molar 2.83 3

MSE HYRAX

SUTURE OPENING 18.3(61%)

Canine 4.8 -

I pre-molar 4.5 -

II pre-molar 4.5 -

Molar 4.5 -

ALVEOLAR

EXPANSION

6(20%) 7.22(46%)

Canine 1.2 1.1

I pre-molar 1.3 2.16

II pre-molar 1.5 1.66

Molar 2 2.3

CHANGES ABOVE PALATAL PLANE – M.S.E

PRE EXPANSION

POST EXPANSION

Nasal cavity

Zygoma region

Frontonasal region

MSE HYRAX

Nasal cavity 4.166± .7527 - 0.0000

Zygoma 2.666±.816 - 0.0000

Frontonasal level .5 ±.8366 - 0.1739

CHANGES ABOVE PALATAL PLANE

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EXPANSION PATTERN

0

Zygoma

Nasal cavity5

2

1

Orbital

Fronto-nasal

NASAL AND CRANIAL STRUCTURE

EXPANSION PATTERN

AXIAL SLICE AT THE LEVEL OF MID-PALATAL SUTURE

9Incisor

Canine

I Pre-molar

II Pre-molar

6

6

6

7

I- Molar

N LEFT RIGHT P-VALUE MEAN

MSE 10 2.41 ±1.72 2.03± 1.52 0.3632 3.56

Hyrax 10 - - - -

Alveolar Expansion

Dental Expansion

0

0

0

0

2.5

3.0

HYRAX

Intermolar width

Alveolar width

Suture Opening

Nasal cavity

Zygoma

Frontonasal level

M.S.E

4.1

2.6

.5

4.8

6.0

7.0

Skeletal

Expansion

OVERALL EXPANSION

M.S.E

TOTAL EXPANSION-7mm

Skeletal =61%

Alveolar =20%

Dental=19%

HYRAX

TOTAL EXPANSION-3mm

Skeletal =0%

Alveolar=46%

Dental=54%

0%

10%

20%

30%

40%

50%

60%

70%

M.S.E HYRAX

SKELETAL ALVEOLAR DENTAL

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The skeletal gain in our sample accounts for 61% of total expansion and is higher than

the 50% skeletal expansion that has been reported by Profitt and 40% by Kartalian et al.

and 55% reported by Garrett et al.

The greater percentage of skeletal expansion in our sample can be attributed to the better

anchorage potential of the four miniscrews that are capable of bi-cortical engagement in

this design.

Tausche et al. using CT has documented - 85%–91% of expansion achieved was skeletal

in nature. However, in their participants, a surgical intervention was employed along

with distraction unlike in our sample where no surgeries were performed

The MSE produced more skeletal changes compared to conventional RME

device.

There are negligible changes at the crown level, in the posterior segment with

MSE when compared to conventional hyrax RME device.

Vertical alveolar bone loss due to buccal bone dehiscences of the anchor teeth

was seen more with hyrax expander device than MSE.

Maxillary Skeletal Expander produces significant increase in airway volume of

the nasopharynx and nasal cavities as well in anterior and posterior widths of the

nasal floor when compared to rapid maxillary expansion.

Improves the esthetics by reducing the negative buccal corridor

conclusion…