Comparison of Tooth- and Bone-Borne Appliances on the Stress Distributions and Displacement Patterns in the Facial Skeleton in Surgically Assisted Rapid Maxillary Expansion—A Finite Element Analysis (FEA) Study

Abstract

The aim of this study was to compare the reduced stresses according to Huber’s hypothesis and the displacement pattern in the region of the facial skeleton using a tooth- or bone-borne appliance in surgically assisted rapid maxillary expansion (SARME). In the current literature, the lack of updated reports about biomechanical effects in bone-borne appliances used in SARME is noticeable. Finite element analysis (FEA) was used for this study. Six facial skeleton models were created, five with various variants of osteotomy and one without osteotomy. Two different appliances for maxillary expansion were used for each model. The three-dimensional (3D) model of the facial skeleton was created on the basis of spiral computed tomography (CT) scans of a 32-year-old patient with maxillary constriction. The finite element model was built using ANSYS 15.0 software, in which the computations were carried out. Stress distributions and displacement values along the 3D axes were found for each osteotomy variant with the expansion of the tooth- and the bone-borne devices at a level of 0.5 mm. The investigation showed that in the case of a full osteotomy of the maxilla, as described by Bell and Epker in 1976, the method of fixing the appliance for maxillary expansion had no impact on the distribution of the reduced stresses according to Huber’s hypothesis in the facial skeleton. In the case of the bone-borne appliance, the load on the teeth, which may lead to periodontal and orthodontic complications, was eliminated. In the case of a full osteotomy of the maxilla, displacements in the buccolingual direction for all the variables of the bone-borne appliance were slightly bigger than for the tooth-borne appliance.

Complications of Surgically Assisted Rapid Maxillary/Palatal Expansion (SARME/SARPE)—A Retrospective Analysis of 185 Cases Treated at a Single Center

“…Serious complications resulting from uncontrolled fractures of the facial skeleton and cranial base and damage to vascular and neural structures as a result of SARPE are rarely reported [19,[30][31][32]. It is now known that a maxillary incision along the Le Fort I line and separation at the palatal suture results in expansion without negative effects on distant structures of the facial skeleton and neurocranium [33,34].…”

Comparison of the effects of different rapid maxillary expansion techniques on craniofacial structures: a finite element analysis study

“…In this study, the levels stress accumulation and displacement in the midpalatal and circummaxillary sutures were found in descending order as the bone-borne, tooth-borne, and hybrid groups [ 22 , 23 ]. Although bone anchorage was taken in the hybrid group, the findings of our study showed that better force transfer and displacement were achieved by providing more tooth anchorage in the tooth-borne group.…”

Use of fan beam computerized tomography and cone beam computerized tomography in oral and maxillofacial surgery and its indications: A literature review

“…-Researches available only by abstracts; -Researches with unclear, poorly or inappropriate methods. Studies whose scope was relevant to the topic [20][21][22], but located outside the period of the search, were included and considered as complementary. These were used as a source of conceptual or illustrative bases in the body of the present study.…”

“…Furthermore, it also helps in the planning and monitoring of orthognathic surgery, enabling the reproduction of operative predictability and allowing the observation of anatomical structures of relevance to surgery in a more detailed and expanded way [22].…”