Journal of Prevention and Treatment for Stomatological Diseases ›› 2020, Vol. 28 ›› Issue (10): 657-663.doi: 10.12016/j.issn.2096-1456.2020.10.008

• Prevention and Treatment Practice • Previous Articles     Next Articles

Effect of personalized miniscrew-assisted rapid palatal expander on expansion of the median palatal suture in adults

WANG Chunlin1(),LAN Zedong2,MAO Qin1,LIN Difu3,XU Chanjuan1,LIU Conghua1()   

  1. 1. Dapartment of Orthodontics, Stomatological Hospital, Southern Medical University, Guangzhou 510280, China
    2. Shenzhen Stomatological Hospital, Southern Medical University, Shenzhen 518001, China
    3. Shenzhen Defu Dental Clinic, Shenzhen 518031, China
  • Received:2019-11-25 Revised:2020-05-01 Online:2020-10-20 Published:2020-09-01
  • Contact: Conghua LIU E-mail:1982951887@qq.com;liuchod@163.com

Abstract:

Objective To investigate the manufacturing procedures of personalized miniscrew-assisted rapid palatal expanders (pMARPE) using digital technologies and to evaluate the effect of the expanders when expanding the midpalatal suture of an adult. Methods Digital technologies were used to make pMARPE, which was used to treat a 21-year-old woman with maxillary transverse deficiency (MTD). The relevant literature on MARPE was reviewed. Results PMARPE could be manufactured using intraoral digital scanning, computer-aided design and computer-aided manufacturing(CAD/CAM ), and 3D printing technologies. After expansion, the width of the anterior midpalatal suture, posterior midpalatal suture and maxillary skeletal width increased by 3.9 mm, 3.2 mm and 4.7 mm, respectively. There was no significant change in the inclination of maxillary first molars, and the height of alveolar ridge decreased slightly. It could be seen that using digital technologies to manufacture personalized expanders was possible for MARPE , and the initial stability of miniscrews played an important role in the expansion success rate, the increase of molar inclination is composed of many parts, and the decrease of alveolar ridge height may be overestimated due to the measurement method, as shown by a literature review. Conclusion The midpalatal suture of an adult patient with MTD could be expanded by pMARPE. However, the effect of this expander on the inclination of the first molar and alveolar bone height needs to be further studied with a larger sample size.

Key words: miniscrew-assisted rapid palatal expander, maxillary transverse deficiency, midpalatal suture, intraoral digital scanning, CAD/CAM, 3D printing technology

CLC Number: 

  • R78

Figure 1

Clinical photos and medical imaging results of the patient with MTD a: facial photographs, chin deviation to the right side, convex profile, normal maxilla, retrusive mandible and the long lower third; b-f: intraoral photographs, class Ⅱ molar and canine relationship, anterior teeth open bite, 16/46, 17/47 crossbite; g: panoramic radiograph, with dental germs of 18, 28 and 38; h: lateral radiograph, class Ⅱ skeletal growth pattern, high angle pattern, normal maxilla, retrusive mandible and chin.; i: maxillary skeletal width; j: mandibular skeletal width; MTD: maxillary transverse deficiency"

Figure 2

The CAD/CAM process of pMARPE and miniscrew implantation guide a: virtual superimposition of intraoral scanner image and CBCT reconstructed image; b: position design of miniscrews (arrow 1: incisive foramen; arrow 2: midpalatal suture); c: the best region for miniscrew implantation: 3.0-6.0 mm posterior to the incisive foramen and 1.5-2.7 mm lateral to the midpalatal suture; d: digital design of pMARPE bracket; e: occlusal view of the pMARPE bracket after welding the prefabricated expansion screw; f: the digital design of miniscrew implantation guide; g: occlusal view of the pMARPE and miniscrew implantation guide; pMARPE: personalized miniscrew-assisted rapid palatal expander"

Figure 3

Intraoral situation and three-dimensional position of the implanted miniscrews after implanting four miniscrews into the patient with MTD a: implantation process of four miniscrews; b: maxillary situation after placing pMARPE; c: the position of miniscrews on sagittal plane; d: the position of miniscrews on coronal plane; e: the position of miniscrews on axial plane; MTD: maxillary transverse deficiency; pMARPE: personalized miniscrew-assisted rapid palatal expander"

Figure 4

Clinical photos and CBCT images of the patient with MTD after maxillary expansion a: facial photographs after expansion, presence of interincisal diastema; b-f: intraoral photographs after expansion, presence of interincisal diastema, elimination of 16/46, 17/47 crossbite; g: position of miniscrews on the sagittal plane after expansion; h: position of miniscrews on the coronal plane after expansion; i: position of miniscrews on the axial plane after expansion; MTD: maxillary transverse deficiency"

Figure 5

Three-dimensional superimposition before and after the maxillary expansion of the patient with MTD Obvious lateral displacement of the left and right maxilla and almost no change in the inclination of 16, 26; MTD: maxillary transverse deficiency"

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