Stability of Surgically Assisted Rapid Palatal Expansion

Abstract

The aim of this study was to evaluate the orthodontic retention of maxillary skeletal stability after surgically assisted rapid palatal expansion (SARPE). Ninety digitized plaster casts from 30 adult patients who underwent SARPE were assessed. Thirty patients were divided equally into two groups: the No Retention Group (n = 15) and the Retention Group (n = 15) with a Transpalatal Arch [TPA]). After the end of expansion, the expander appliance was stabilized and remained in place for 4 months. The additional retention period began in the Retention Group as soon as the expander was removed and replaced by a TPA. During the same period, the No Retention Group remained without retention. The casts were created pre-operatively, at 4 months and 10 months post-expansion. The models were digitized by means of a 3D Vivid 9i laser scanner. The palatal area and volume were assessed. Both variables increased after 4 months compared with pre-operative values (p < .05). At 10 months, patients' palatal areas and volumes were stable in both groups (p > .05). In conclusion, no retention other than the expander appliance is needed after SARPE.

Two- and Three-Segment Surgically Assisted Rapid Maxillary Expansion: A Clinical Trial

“…In the attempt to improve the outcome of surgically assisted maxillary expansion application, some authors advocate for two parallel osteotomies performed bilaterally to the median palatine suture (three-segment surgically assisted maxillary expansion) instead of the originally proposed single one along this anatomical feature (two-segment surgically assisted maxillary expansion). 5,6,[9][10][11][12][13][14] The reported improved outcomes of three-segment surgically assisted maxillary expansion are lower rates of asymmetric expansion, more stable dimensional changes in the palate vault, smaller increase in nose width, and lower psychological distress, as the temporary diastema between central incisors is replaced by two smaller ones between lateral incisor and canine. [15][16][17][18] The present study was designed with the aim of ensuring that both two-and three-segment surgically assisted maxillary expansion techniques were performed and observed under the same possibly influencing conditions.…”

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Although surgically assisted rapid maxillary expansion is widely applied to correct transverse maxillary discrepancies in adults, the number and site of osteotomies, activation protocol of expanding device, time allowed for osseous consolidation, and use of a specific type of device following surgically assisted rapid maxillary expansion retention are not established as a strict consensus. [1][2][3][4][5][6] This mostly stems from weak evidence reported in studies with less than ideal experimental design. 7,8 Basically, two operative techniques are used in surgically assisted rapid maxillary expansion: the first is known as a bipartite or two-segment technique, which includes as main feature the osteotomy along the median palatine suture 5,6,[9][10][11][12][13][14] ; and the second is referred to as a tripartite or threesegment technique, whose main feature is two paramedian osteotomies instead.

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“…[1][2][3][4][5][6] This mostly stems from weak evidence reported in studies with less than ideal experimental design. 7,8 Basically, two operative techniques are used in surgically assisted rapid maxillary expansion: the first is known as a bipartite or two-segment technique, which includes as main feature the osteotomy along the median palatine suture 5,6,[9][10][11][12][13][14] ; and the second is referred to as a tripartite or threesegment technique, whose main feature is two paramedian osteotomies instead. There are few studies in the literature comparing the outcomes of these two surgical techniques.…”

“…Although surgically assisted rapid maxillary expansion is widely applied to correct transverse maxillary discrepancies in adults, the number and site of osteotomies, activation protocol of expanding device, time allowed for osseous consolidation, and use of a specific type of device following surgically assisted rapid maxillary expansion retention are not established as a strict consensus. 1–6 This mostly stems from weak evidence reported in studies with less than ideal experimental design. 7,8…”

How Effective Are the Nance Appliance and Transpalatal Arch at Reinforcing Anchorage in Extraction Cases?

“…In a randomized trial by Prado et al [ 49 ], the stability of surgically assisted rapid palatal expansion was evaluated with and without the use of a transpalatal arch for retention. The study involved 30 adult patients divided into two groups: one with TPA as an anchorage and a control group.…”