Dental and Medical Problems

Dent Med Probl
Index Copernicus (ICV 2021) – 132.50
MEiN – 70 pts
CiteScore (2021) – 2.0
JCI (2021) – 0.5
Average rejection rate (2022) – 79.69%
ISSN 1644-387X (print)
ISSN 2300-9020 (online)
Periodicity – quarterly

Download PDF

Dental and Medical Problems

2016, vol. 53, nr 1, January-March, p. 134–141

doi: 10.17219/dmp/60884

Publication type: clinical case

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Creative Commons BY-NC-ND 3.0 Open Access

An Analysis of Early Changes to the Craniofacial Skeleton Induced by Transpalatal Distraction in a Patient with Maxillary Constriction, Based on Computed Tomography Scans – Case Report

Analiza wczesnych zmian w szkielecie czaszki twarzowej po leczeniu zwężenia szczęk metodą dystrakcji przezpodniebiennej na podstawie tomografii komputerowej – opis przypadku

Rafał Nowak1,A,D,E,F, Ewa Zawiślak1,B,C,D

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


Transpalatal distraction is a recognized surgical treatment of transverse maxillary deficiency in adult patients. In skeletally mature individuals, rapid maxillary expansion (RME) is ineffective or leads to dental and periodontal complications. Transpalatal distraction works on the principle of distraction osteogenesis, increasing the maxillary base width and its transverse dimensions. Skeletal expansion of the maxilla will lead to an increase in the volume of the nasal cavity with proper conversion of the nasal breathing track. The increase in width of the maxilla will also overcome the unsightly dark corridors during a smile. The clinical manifestation of the maxillary expansion during active distraction treatment is the emergence of diastema between the maxillary central incisors. Currently available diagnostic imaging techniques such as computed tomography (CT) and 3D image reconstruction of craniofacial bone structure enable precise analysis of active treatment. The paper presents the case of a 29-year-old woman with maxillary constriction and skeletal class III malocclusion, treated with transpalatal distraction. The changes in maxillofacial complex were quantified based on the selected axial computed tomography scans taken before and after the end of active treatment. Furthermore, a 3D reconstruction of the craniofacial skeleton was performed so as to obtain a realistic picture of TPD-induced changes.

Key words

computed tomography, maxillary constriction, transpalatal distraction, crossbite

Słowa kluczowe

tomografia komputerowa, zwężenie szczęki, dystrakcja przezpodniebienna, zgryz krzyżowy

References (17)

  1. Biedziak B.: Evaluation of changes in the upper dental arch after palatal expansion. Czas. Stomatol. 2009, 62, 764– 772 [in Polish].
  2. Bailey L.J., White R.P., Proffit W.R., Turvey T.A.: Segmental LeFort I osteotomy for management of transverse maxillary deficiency. J. Oral Maxillofac. Surg. 1997, 55, 728–731.
  3. Koudstaal M.J., Poort L.J., Van der Wal K.G.H., Wolvius E.B., Prahl-Andersen B., Schulten A.J.M.: Surgically assisted rapid maxillary expansion (SARME): a review of the literature. Int. J. Oral Maxillofac. Surg. 2005, 34, 709–714.
  4. Mommaerts M.Y.: Transpalatal distraction as a method of maxillary expansion. Br. J. Oral Maxillofac. Surg. 1999, 37, 268–272.
  5. Pinto P.X., Mommaerts M.Y., Wreakes G., Jacobs W.V.J.A.: Immediate postexpansion changes following the use of the transpalatal distractor. J. Oral Maxillofac. Surg. 2001, 59, 994–1000.
  6. 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.
  7. Baysal A., Karadede I., Hekimoglu S., Ucar F., Ozer T., Veli I., Uysal T.: Evaluation of root resorption following rapid maxillary expansion using cone-beam computed tomography. Angle Orthod. 2012, 82, 488–494.
  8. Boryor A., Hohmanna A., Wunderlich A., Geiger M., Kilic F., Sander M., Sander C., Bockers T., Sander F.G.: In vitro results of rapid maxillary expansion on adults compared with finite element simulations. J. Biomech. 2010, 43, 1237–1242.
  9. Gautam P., Valiathan A., Adhikaric R.: Stress and displacement patterns in the craniofacial skeleton with rapid maxillary expansion: A finite element method study. Am. J. Orthod. Dentofacial Orthop. 2007, 132, 5, e1-5.e11.
  10. Chrcanovic B.R., Custódio A.L.: Orthodontic or surgically assisted rapid maxillary expansion. Oral Maxillofac. Surg. 2009, 13, 123–137.
  11. Biedziak B.: Orthodontic palatal expansion – assessment widening of maxilla and nasal cavity in computed tomography scans. Czas Stomatol. 2009, 62, 912–921 [in Polish].
  12. Seeberger R., Kater W., Schulte-Geers M., Davids R., Freier K., Thiele O.: Changes after surgically-assisted maxillary expansion (SARME) to the dentoalveolar, palatal and nasal structures by using tooth-borne distraction devices. Br. J. Oral Maxillofac Surg. 2011, 49, 381–385.
  13. Kamińska I.: Orthodontic effect of palatal expansion. Ann. Pomeranian Med. Univ. Szczecin, 2008, 54, 94–105 [in Polish].
  14. Koudstaal M.J., Smeets J.B.J., Kleinrensink G.J., Schulten A.J.M., Van der Wal K.G.H.: Relapse and stability of surgically assisted rapid maxillary expansion: an anatomic biomechanical study. J. Oral Maxillofac. Surg. 2009, 67, 10–14.
  15. Goldenberg D.C., Goldenberg F.C., Alonso N., Gebrin E.S., Amaral T.S., Scanavini M.A., Ferreira M.C.: Hyrax appliance opening and pattern of skeletal maxillary expansion after surgically assisted rapid palatal expansion: a computed tomography evaluation. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2008, 106, 812–819.
  16. Pereira M.D., Prado G.P.R., Abramoff M.M.F., Aloise A.C., Ferreira L.M.: Classification of midpalatal suture opening after surgically assisted rapid maxillary expansion using computed tomography. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 2010, 110, 41–45.
  17. Strzecki A., Miechowicz S., Pawłowska L.: Analysis of dental and skeletal changes after rapid maxillary expansion – CBCT and 3D digital model – case report. J. Stoma. 2014, 67, 99–113.