Rapid maxillary expansion: a review of appliance designs, biomechanics and clinical aspects

Almuzian, Mohammed; Short, Laura J.; Isherwood, Grant; Al-Muzian, Lubna; McDonald, James

doi:10.12968/ortu.2016.9.3.90

Cited by 7 publications

(7 citation statements)

References 28 publications

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“…While RME facilitates opening of the medial palatal suture and expansion of the maxilla, it has some undesirable effects. Histological and radiography studies have shown that the heavy forces applied by RME appliances 1 induce and cause external root resorption on the anchor teeth. 2 - 7 Clinicians can use various RME appliances to widen the maxilla, such as tooth-borne and tooth–tissue-borne banded or bonded appliances.…”

Section: Introductionmentioning

confidence: 99%

Does mini-implant-supported rapid maxillary expansion cause less root resorption than traditional approaches? A micro-computed tomography study

Alçin

Malkoç²

2021

Korean J Orthod

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Objective This study aimed to evaluate the volume, amount, and localization of root resorption in the maxillary first premolars using micro-computed tomography (micro-CT) after expansion with four different rapid maxillary expansion (RME) appliances. Methods In total, 20 patients who required RME and extraction of the maxillary first premolars were recruited for this study. The patients were divided into four groups according to the appliance used mini-implant-supported hybrid RME appliance, hyrax RME appliance, acrylic-bonded RME appliance, and full-coverage RME appliance. The same activation protocol (one activation daily) was implemented in all groups. For each group, the left and right maxillary first premolars were scanned using micro-CT, and each root were divided into six regions. Resorption craters in the six regions were analyzed using special CTAn software for direct volumetric measurements. Data were statistically analyzed using Kruskal–Wallis one-way analysis of variance and Mann–Whitney U test with Bonferroni adjustment. Results The hybrid expansion appliance resulted in the lowest volume of root resorption and the smallest number of craters ( p < 0.001). In terms of overall root resorption, no significant difference was found among the other groups ( p > 0.05). Resorption was greater on the buccal surface than on the lingual surface in all groups except the hybrid appliance group ( p < 0.05). Conclusions The findings of this study suggest that all expansion appliances cause root resorption, with resorption craters generally concentrated on the buccal surface. However, the mini-implant-supported hybrid RME appliance causes lesser root resorption than do other conventional appliances.

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Section: Introductionmentioning

confidence: 99%

Does mini-implant-supported rapid maxillary expansion cause less root resorption than traditional approaches? A micro-computed tomography study

Alçin

Malkoç²

2021

Korean J Orthod

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“…The conventional activation protocol for RME appliances is two turns per day until the desired expansion has been achieved. 4,5 However, some investigators have claimed that rapid separation of the maxillary bones results in a relapse tendency in the long term and that relatively slower expansion of the maxilla would probably produce less tissue resistance on the surrounding structures. Therefore, they recommend two turns each day for the first 5 days and three turns each week afterward, namely, semirapid maxillary expansion (SRME).…”

Section: Introductionmentioning

confidence: 99%

“…However, the magnitude of the forces required to separate the mid-palatal suture is approx-imately 900À4500 g, which is very high compared with what is required to move teeth. 1,4,5 Severe forces are applied to the upper premolar and molar teeth, inducing hyalinization of their periodontium. This allows a transfer of loading to the maxillary halves, promoting opening of the midpalatal suture.…”

Section: Introductionmentioning

confidence: 99%

“…4,5 Notable complications that may occur after an RME procedure are bone dehiscence and root resorption of the anchor teeth due to the heavy forces. 4,[7][8][9][10][11] The examination of root resorption craters in threedimensional (3D) configurations with high-dimensional resolutions is possible using micro-computed tomography (micro-CT). [11][12][13] Micro-CT has been used as an imaging and evaluation technique in different fields of dentistry.…”

Section: Introductionmentioning

confidence: 99%

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Does the rhythm and appliance type of rapid maxillary expansion have an effect on root resorption?

Malkoç¹,

Alçin²,

Uzel³

2021

The Angle Orthodontist

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Objectives To evaluate the volume, amount, and localization of root resorption in the upper first premolars by micro–computed tomography (micro-CT) after three different rapid maxillary expansion appliances and two different activation rhythms. Materials and Methods The patients were divided into three groups; Hyrax, acrylic cap splint (ACS), and full coverage acrylic bonded (FCAB) appliances. Each group was then divided into the following two subgroups: rapid maxillary expansion (RME) and semirapid maxillary expansion (SRME). After expansion was completed, the appliances were stabilized for 12 weeks during the retention period. For each group, 10 premolars (for a total of 60 premolars) were scanned with the micro-CT (SkyScan). The reconstructed 3D images of each root sample were divided into six regions. The resorption craters on these six different root surfaces were analyzed by special CTAn (SkyScan) software for direct volumetric measurements. Kruskal-Wallis one-way analysis of variance and Mann-Whitney U tests were used for statistical analysis. Results The total volume of root resorption was less with FCAB than with ACS and Hyrax (P < .001). In all groups, a greater volume of resorption was found on the buccal surface than on the lingual surface (P < .001). No significant differences were found between the RME and SRME groups (P > .05). Conclusions All expansion appliances caused root resorption in the upper first premolar teeth, but FCAB may be safer in terms of root resorption. The resorption craters were generally concentrated on the buccal surface. There was no effect of activation rhythm on root resorption.

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“…There are several designs for RME appliances including tooth-borne, tooth-tissue-borne, bone-borne, or hybrid types. However, it has been reported that bone-anchored RME can overcome the drawbacks associated with conventional tooth-borne and tooth-tissue-borne appliances, including tipping and periodontal damage of the anchor teeth [8, 9, 13]. Most recently, a new RME protocol was advocated for the treatment of class III malocclusions in cleft palate patients, in which the maxilla is alternately expanded and constricted in a weekly cycle over a period of 4–6 weeks [14–16].…”

Section: Introductionmentioning

confidence: 99%

3D effects of a bone-anchored intra-oral protraction in treating class III growing patient: a pilot study

et al. 2019

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Objectives The aim of this prospective case series study is to assess the three-dimensional (3D) skeletal and soft tissue effects of the alternate rapid maxillary expansion and constriction (Alt-RAMEC) protocol in conjunction with a miniscrew-supported class III elastic wear in class III growing patients. Materials and methods Fourteen consecutive participants (mean age 12.05 ± 1.09 years), who displayed class III malocclusions with retrognathic maxillae, were recruited. A cone beam computed tomography (CBCT) scan was acquired before commencing treatment (T1). All participants were treated with a tooth-bone-borne rapid maxillary expansion (hybrid MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. This was followed by full-time class III elastics, delivering 400 g/side, to protract the maxilla. When a positive overjet was achieved, protraction was ceased and a post-treatment CBCT scan (T2) was taken. The 3D analysis of pre- and post-treatment CBCT scans was blinded. The scans were registered on the anterior cranial base. The Euclidean distance between the two extracted surface models of the pre- and post-treatment scans was displayed as a color surface map. Results All participants completed the intervention successfully. The majority of the participants showed protraction of the anterior maxillary region (71.4%) and in the zygomatic processes (64.2%). The maxilla significantly protracted (SNA 1.87° ± 1.06°; Vert.T-A 3.29 ± 1.54 mm), while the mandibular base significantly redirected posteriorly (SNB − 2.03° ± 0.85°, Vert.T-B − 3.43 ± 4.47 mm) and that was reflected on the ANB and Wits measurements. No adverse effects were observed. Conclusion Class III elastics combined with the Alt-RAMEC activation protocol of the hybrid MARME appliance is an effective treatment method for mild/moderate class III malocclusions. A long-term follow-up and comparisons with other treatment modalities are required.

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Rapid maxillary expansion: a review of appliance designs, biomechanics and clinical aspects

Cited by 7 publications

References 28 publications

Does mini-implant-supported rapid maxillary expansion cause less root resorption than traditional approaches? A micro-computed tomography study

Does mini-implant-supported rapid maxillary expansion cause less root resorption than traditional approaches? A micro-computed tomography study

Does the rhythm and appliance type of rapid maxillary expansion have an effect on root resorption?

3D effects of a bone-anchored intra-oral protraction in treating class III growing patient: a pilot study

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