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The articulatory displacement of maxillary bones during and after rapid maxillary expansion (RME) was studied with metallic implants and roentgen stereometry (RSA) for 3653 days in a girl aged 12 at start of treatment. She had a narrow upper dental arch with anterior crowding and a normal incisor relationship, and a normal sagittal molar relationship with bilateral cross-bite. Three implants were inserted in each maxillary bone and they remained stable in the bones during the 10-year observation period. In the 3-D analysis of the articulatory displacement, the left maxillary bone was studied in relation to the right bone in three periods: RME (23 days), retention (108 days) and follow-up (3522 days). Extensive relapse of rotations as well as translations was found and the long-term effect of RME was limited. In our opinion the relapse was caused mainly by the resistance to deformation from circum-maxillary sutures and surrounding soft tissue matrix, and inadequate bone formation in the involved sutures. As is generally known in clinical oral orthopaedics, changes obtained by short-term simple mechanical interference with a complex biological system tend to reverse spontaneously. Thus, the rationale for RME treatment may be seriously questioned.

Bone grafts are used to lengthen the dorsum and elevate the tip of the nose in patients with Binder's syndrome. Disappointing long-term results in some patients generally have been assumed to be a result of resorption and/or displacement of the grafts. Treatment outcome was studied in 11 patients with the use of serial profile roentgenograms. At 40 months, the mean values after surgery were reduction of the initial transplant length by 28 percent and reduction of the transplant angle by 4 degrees. The initial nose length was increased by 1 mm, and nose tip projection was increased by 2 mm. Although the mean changes of nose length and nose tip projection seemed small, treatment outcome varied considerably between patients. In contrast with earlier assumptions, no correlation could be found between the degree of transplant resorption and/or displacement and the effect of surgery on nose length and nose tip projection.