Dental and Medical Problems

Dent Med Probl
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ISSN 1644-387X (print)
ISSN 2300-9020 (online)
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Dental and Medical Problems

2015, vol. 52, nr 4, October-December, p. 389–400

doi: 10.17219/dmp/59388

Publication type: editorial article

Language: English

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Creative Commons BY-NC-ND 3.0 Open Access

Treatment Options and Limitations in Transverse Maxillary Deficiency

Możliwości i ograniczenia leczenia niedorozwoju poprzecznego szczęk

Rafał Maciej Nowak1,A,B,D,E,F, Alina Strzałkowska2,B,C,D, Ewa Zawiślak3,B,C,D

1 Department of Maxillofacial Surgery, Wroclaw Medical University, Wrocław, Poland

2 Private Practice “Orthosmile”, Wrocław, Poland


Maxillary constriction is clinically manifested as a narrow palate and a high palatal vault, a complete unilateral or bilateral crossbite, dark buccal corridors, unaesthetic appearance and a significant disproportion between the width of the upper and lower dental arches. Structural maxillary abnormality may also be associated with such functional impairments as food chewing disorder, nose breathing problems and a development of a mouth breathing habit. The purpose of this paper is to present and discuss the most common therapeutic approaches in the management of transverse maxillary deficiency. The increased transverse dimension may be achieved orthodontically by expansion, with surgical assistance – surgically assisted rapid maxillary expansion – or using purely surgical techniques. Surgical options include transpalatal distraction and segmented maxillary osteotomy. Orthodontic maxillary expansion is effective at developmental age due to the continuous bone growth, until the closure of the midpalatal suture. As the risk of orthodontic treatment failure is higher in adults with maxillary constriction, these patients make good candidates for surgery. The optimum maxillary expansion approach should be chosen based on such unambiguous criteria as patient’s age, severity of deformity and the skills of the therapeutic team.

Key words

rapid maxillary expansion, maxillary constriction, transpalatal distraction, surgically assisted rapid maxillary expansion

Słowa kluczowe

zwężenie szczęki, poszerzenie szczęki, dystrakcja przezpodniebienna, chirurgicznie wspomagane poszerzenie szczęki

References (39)

  1. Ciambotti C., Nagan P., Durknee M., Kohli K., Kim H.: A comparsion of dental and dentoalveolar beetween rapid palatal expansion and nickiel-titanium palatal expansion appliances. Am. J. Orthod. Dent. Orthop. 2001, 119, 11–20.
  2. Mommaerts M.Y.: Transpalatal distraction as a method of maxillary expansion. Br. J. Oral Maxillofacial. Surg. 1999, 37, 268–272.
  3. Wertz R.A.: Rapid expansion of the maxillary dental arch and nasal cavity by opening the mid-palatal suture. Angle Orthod. 1961, 31, 73–90.
  4. Haas A.J.: Palatal expansion: Just the beginning of dentofacial orthopedics. Am. J. Orthod. 1970, 57, 219–255.
  5. Kamińska I.: Orthodontic effects of midpalatal suture separation. Ann. Acad. Med. Stettin. 2008, 54, 1, 94–105 [in Polish].
  6. Proffit W.R., Fields H.W.: Ortodoncja współczesna. Wyd. Czelej, Lublin 2000.
  7. Persson M., Thilander B.: Palatal suture closure in man from 15 to 35 years of age. Am. J. Orthod. 1977, 72, 42–45.
  8. Bishara S.E., Stale R.N.: Maxillary expansions: clinical implications. Am. J. Orthod. Dentofacial Orthop. 1987, 91, 3–14.
  9. Filhoa R.L., Ruellas A.C.: Long-term maxillary changes in patients with skeletal Class II malocclusion treated with slow and rapid palatal expansion. Am. J. Orthod. Dentofacial Orthop. 2008,134, 383–388.
  10. Mustafa A., Mustafa E., Kurzawski M.: Orthodontic method of maxillary expansion. Dental Forum. 2005, 33, 2, 75–79 [in Polish].
  11. Kurzawski M., Biedziak B.: Construction and function of nickiel titanium palatal expande (NPE-2). Dent. Med. Probl. 2004, 41, 549–552 [in Polish].
  12. Erdnic A.E., Uður T., Erbay E.: A comparison of different treatment techniques for posterior cross bite in mixed dentition. Am. J. Orthod. Dentofacial Orthop. 1999, 115, 569–575.
  13. Lagravere M.O., Carey J.P., Heo G., Toogood R.W., Major P.W.: Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: randomized clinical trial. Am. J. Othod. Dentofacial Orthop. 2010, 137, 304–305.
  14. Weissheimer A., de Menezes L.M., Mezomo M., Dias D.M., de Lima E.M.S., Rizzatto S.M.D.: Immediate effects of rapid maxillary expansion with Haas-type and hyrax-type expanders: a randomized clinical trial. Am. J. Othod. Dentofacial Orthop. 2011, 140, 366–376.
  15. Garib D.G., Henriques J.F., Janson G., de freitas M.R., Fernandes A.Y.: Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-tissue expanders: a computed tomography evaluation. Am. J. Orthod. Dentofacial Orthop. 2006, 129, 749–758.
  16. Karłowska I.: Contemporary orthodontics. Wydawnictwo Lekarskie PZWL, Warszawa 2009, 269–270 [in Polish].
  17. Clark W.J.: Transforce lingual appliances for arch development. J. Clin. Orthodont. 2005, 39, 137–142.
  18. Talapaneni A.K., Kumar K.P., Kommi P.B., Nuvvula S.: Interceptive orthopedics for the correction of maxillary transverse and sagittal deficiency in the early mixed dentition period. Contemp. Clin. Dent. 2011, 11, 331–336.
  19. Chrcanovic B.R., Custódio A.L.: Orthodontic or surgically rapid maxillary expansion. Oral Maxillofac. Surg. 2009, 13, 123–137.
  20. Suri L., Taneja P.: Surgically assisted rapid palatal expansion: a literature review. Am. J. Orthod. Dentofacial Orthop. 2008, 133, 290–302.
  21. Baratieri C., Alves M., de Souza M.M.G., de Souza Araujo M.T., Maia L.C.: Does rapid maxillary expansion have long-term effects on airway dimensions and breathing? Am. J. Othod. Dentofacial Orthop. 2011, 140, 146–156.
  22. Boysen B., la Cour K., Athanasiou A.E., Gjessing P.E.: Three-dimensional evaluation of dentoskeletal changes after posteriori cross-bite correction by quad-helix or removable appliances. Br. J. Orthod. 1992, 19, 97–107.
  23. Vizzotto M.B., de Araujo F.B., da Silveira H.S., Boza A.A., Closs L.Q.: The quad-helix appliance in the dentitionorthodontic and orthopedic measurement. J. Clin. Pediatr. Dent. 2007, 32, 165–170.
  24. Frank S.W., Engel G.A.: The effects of maxillary quad-helix appliance expansion on cephalometric measurement in growing orthodontic patients. Am. J. Orthod. 1982, 81, 378–389.
  25. Sandikcioglu M., Hazar S.: Skeletal and dental changes after maxillary expansion in the mixed dentition. Am. J. Orthod. Dentofacial Orthop. 1997, 111, 321–327.
  26. Végh A., Dénes Z., Razouk G., Dénes J.: The development and action-mechanism of the quadhelix in orthodontic treatment. Fogorv Sz. 1999, 92, 143–150.
  27. McNally M.R., Spary D.J.: A randomized controlled trial comparing the quadhelix and the expansion arch for the correction of crossbite. J. Orthod. 2005, 32, 29–35.
  28. Huynh T., Kennedy D.B., Joondeph D.R., Bollen A.M.: Treatment response and stability of slow maxillary expansion using Haas, hyrax, and quad-helix appliances – a retrospective study. Am. J. Orthod. Dentofacial Orthop. 2009, 136, 331–339.
  29. Handelman C.: Palatal expansion in adults: the nonsurgical approach. Am. J. Orthod. Dentofacial Orthop. 2011, 140, 4–11.
  30. Iseri H., Ozsoy S.: Semirapid maxillary expansion – a study of long-term transverse effects in older adolescents and adults. Angle Orthod. 2004, 74, 71–78.
  31. Kartalian A., Gohl E., Adamian M., Enciso R.: Cone-beam computerized tomography evaluation of the maxillary dentoskeletal complex after rapid palatal expansion. Am. J. Orthod. Dentofacial Orthop. 2010, 138, 486–492.
  32. Laptook T.: Conductive hearing loss and rapid maxillary expansion. Am. J. Orthod. 1981, 80, 325–331.
  33. Kulewicz M.: Dystraction osteoganesis in orthognathic surgery. Acta Cinica 2001, 2, 117–128.
  34. Northway W.: Palatal expansion in adults: the surgical approach. Am. J. Orthod. Dentofacial Orthop. 2011, 140, 463–469.
  35. Schwarz G.M., Thrash W.J., Byrd D.L., Jacobs J.D.: Tomographic assessment of nasal septal changes following surgical – orthodontic rapid maxillary expansion. Am. J. Orthod. Dentofacial Orthop.1985, 87, 39–45.
  36. Matteini C., Mommaerts M.Y.: Posterior transpalatal distraction with pterygoid disjunction: a short-term model study. Am. J. Orthod. Dentofacial Orthop. 2001, 120, 498–502.
  37. Zahl C., Gerlach K.L.: Palatinaldistraktor: ein innovativer Ansatz fur die Gaumennahterweiterung. Mund. Kiefer Gesichts Chir. 2002, 24, 446–449.
  38. Strömberg C., Holm J.: Surgically assisted rapid maxillary expansion in adults. A retrospective long-term followup study. J. Craniomaxillofac. Surg. 1995, 23, 222–227.
  39. Koudstaal M.J., Wolvius E.B., Schulten A.J., Hop W.C., Van der Waal K.G.: Stability, tipping and relapse of bone-borne versus tooth-borne surgically assisted rapid maxillary expansion; a prospective randomized patient trial. Int. J. Oral Maxillofac. Surg. 2001, 38, 308–315.