Unilateral and bilateral corticotomies for correction of maxillary transverse discrepancies

Abstract

SUMMARY Surgically-assisted rapid maxillary expansion in adults has been proved effective in overcoming the strong resistance of the maxillary complex after growth is completed, particularly after the second decade of life.The aim of this study was to describe the dental and the skeletal expansion and relapse, as well as the amount of tipping of the two maxillary bones and first permanent molars, during a rapid maxillary expansion procedure combined with unilateral and bilateral corticotomies.The sample consisted of four adult patients, two presenting with bilateral and two with unilateral cross-bite. Records were taken before and after rapid maxillary expansion, at the end of retention and at least 12 months post-retention.In the cases of bilateral cross-bite the same amount of skeletal expansion was observed on both sides. The angular changes measured at the upper first molars indicated important tipping on both sides, which tended to relapse moderately during the retention and post-retention period. Following unilateral surgery, the operated side showed more than twice the amount of skeletal expansion than the non-operated side. The angular changes presented twice as much tipping and relapse on the operated side.The results of this study demonstrate that unilateral cross-bites in adults can be corrected with unilateral corticotomy and rapid maxillary expansion using the contralateral non-operated side as anchorage.Stability appeared satisfactory in all cases.

Incisiones verticales en SARPE

“…7 Bell and Epker later applied the complete Lefort I osteotomy but without the down-fracture, or without separating the lateral nasal wall. 2,[8][9][10] In the decade of the 80s, less aggressive techniques were applied that could be carried out under sedation: lateral wall corticotomies with interincisal osteotomies, 11 lateral wall corticotomies with midpalatal osteotomies through a paramedial palatal incision 12 or a transpalatal incision, 13,14 or palatal osteotomies through the pyriform aperture. 15 There is no clinical evidence as to the need for carrying out pterygomaxillary osteotomies, and they have only been recommended in an experimental study on models.…”

“…7 Bell y Epker posteriormente aplicaron el Lefort I completo pero sin «down-fracture» o sin separación de la pared nasal lateral. 2,[8][9][10] En la década de los 80 se aplicaron técnicas menos agresivas que se podían realizar bajo sedación: corticotomía lateral y osteotomía interincisal, 11 corticotomía lateral y palatina media a traves de una incisión palatina paramedial, 12 o transpalatina, 13,14 u osteotomía palatina a través de la escotadura piriforme. 15 No existen evidencias clínica sobre la necesidad de practicar un osteotomía ptérigomaxilar, siendo solamente recomendada en un trabajo experimental sobre modelos.…”

Changes in Arch Form Following Surgically-assisted Rapid Maxillary Expansion (SRME)

“…Asanza et al [4] found lateral tipping of 10.5° in posteroanterior cephalograms. In a case report, Mossaz et al [28] measured changes in inclination between 11.5° and 25.5° in two patients. As only the changes in this inclination are considered in those comparisons, we can justifiably compare their methods.…”

“…Neubert et al [29] Subtotal LeFort I and midline separation 39 8.5 Zöller & Ullrich [40] Buccal corticotomy, palatal osteotomy 14 6.7 Bays & Greco [5] Buccal corticotomy, osteotomy of the lateral nasal cavity anterior, midline separation 19 5.8 Pogrel et al [32] Buccal corticotomy, palatal osteotomy 12 7.5 Mossaz et al [28] Subtotal LeFort I and midline separation 2 8.3 Stromberg & Holm [37] Subtotal LeFort I without pterygomaxillary separation, palatal osteotomy 20 8.3 Northway & Meade [30] Buccal corticotomy, midline separation 7 5.9 Northway & Meade [30] Buccal corticotomy, palatal osteotomy 16 3.4 Berger et al [7] Subtotal LeFort I osteotomy 29 5.9 Schimming et al [35] Buccal corticotomy 20 6 Chung & Goldman [13] Subtotal LeFort I osteotomy 14 7 Byloff & Mossaz [12] Buccal corticotomy and pterygomaxillary separation 14 8.7…”

Skeletally-anchored Rapid Maxillary Expansion using the Dresden Distractor

“…So konnten im Molarenbereich 85% und im Prämolarenbereich 91% der Gesamterweiterung (gemessen an den Zahnkronen) durch skelettale Erweiterung erreicht werden. Vergleichswerte für chirurgisch unterstützte, zahngetragene GNE fallen geringer aus (Tabelle 2) [6,31,32] the total expansion that was measured on the crowns in the molar and premolar regions, respectively, was achieved skeletally; corresponding values for surgically-assisted, tooth-borne RME are lower (Table 2) [6,31,32]. The dental tipping we observed was 4°-8° less than that demonstrated in the alveolar processes ( Table 1).…”