Maxillary Transverse Discrepancy

R4 王鈴鈞｜ Moderator VS 李翊豪｜ Jan. 20,

2021
• Proffit & White:

30% of adult orthodontic patients have a maxillary

transverse deficiency

Proffit WR, White RP Jr. Who needs surgical-orthodontic treatment? IJAOOS 1990
 OUTLINE

1. Anatomy 5. Treatment

2. Growth 6. Effect

3. Histology 7. MARPE

4. Clinical characteristics 8. Conclusion

Anatomy
Anatomy
Anatomy
 Growth

Adherence zone

Roberts, W. E., & Hartsfield, J. K. Bone development and function: genetic and environmental mechanisms. Seminars
in Orthodontics 2004
• Melson 1975:
• the nasal surface of the hard palate was characterized by resorption
until the age of 14 to 15
• the oral surface of the hard palate was characterized by apposition up
to the age of 13 to 14

Melsen, B. Palatal growth studied on human autopsy material. American Journal of Orthodontics 1975
• Björk & Skieller: growth at the suture might be occurring as late as 13
years of age
• Persson & Thilander: signs of growth in the suture at the age of 13
• Melson: transverse growth of the midpalatal suture continued up to the
age of 16 in girls and 18 in boys
 Growth

• Chronologic age
• Dental developemental age
• CVMS
• Five-stage midpalatal suture method
• Midpalatal suture density ratio (MSDR)
 11-14 y/o: 25% girls
11 y/o 14-18 y/o 57.9% girls
18 y/o : almost

Growth

Angelieri, F et al. Midpalatal suture maturation: Classification method for individual assessment before rapid
maxillary expansion. AJODO 2013
 Growth

A Björk, S Helm Prediction of the age of maximum puberal growth in body height Angle Orthod 1967
 Histology

Melsen, B. Palatal growth studied on human autopsy material. American Journal of Orthodontics 1975
Characteristics
• Narrow palate
• Deepen palatal vault
• Malalignment
• Tapered arch form
• Abrasion over anterior teeth
 Characteristics

• Posterior crossbite
• Functional shift
 Diagnosis
• Paranasal hollowing
• Narrow nasal base
• Deeped nasal labial fold
• Zygomatic hypoplasia

Betts NJ, Vanarsdall RL, Barber HD, Higgins-Barber K, Fonseca RJ. Diagnosis and treatment of transverse maxillary
deficiency. Int J Adult Orthodon Orthognath Surg. 1995
 Diagnosis

• Jacobs :
If a crossbite involves more than one or two teeth, the crossbite is
probably skeletal in nature

J D Jacobs et al. Control of the transverse dimension with surgery and orthodontics Am J Orthod. 1980
 Diagnosis

• McNamara :
maxillary arches less than 31 mm in width may be crowded and
thus in need of orthopedic or surgically assisted expansion.

McNamara JA. Maxillary transverse deficiency. Am J Orthod Dentofacial Orthop 2000

 Diagnosis
• Ricketts 1980: Rocky Mountain analysis

R M Ricketts Perspectives in the clinical application of cephalometrics. The first fifty years Angle Orthod. 1981
 Diagnosis
• Ricketts 1980: Rocky Mountain analysis

R M Ricketts Perspectives in the clinical application of cephalometrics. The first fifty years Angle Orthod. 1981
 Diagnosis
• Ricketts 1980: Rocky Mountain analysis

R M Ricketts Perspectives in the clinical application of cephalometrics. The first fifty years Angle Orthod. 1981
 Diagnosis
• Ricketts 1980: Rocky Mountain analysis
• Maxillomandibular width differential:
>10 mm
• Maxillomandibular difference: 19.6 mm

R M Ricketts Perspectives in the clinical application of cephalometrics. The first fifty years Angle Orthod. 1981
 Diagnosis
• Ricketts 1980: Rocky Mountain analysis
• Maxillomandibular width differential:
>10 mm
• Maxillomandibular difference: 19.6 mm
> 5 mm, SARPE

R M Ricketts Perspectives in the clinical application of cephalometrics. The first fifty years Angle Orthod. 1981
 Diagnosis

Kee-Joon Lee et al. Maxillary transverse expansion in adults: Rationale, appliance design, and treatment outcomes
Seminars in Orthodontics 2018
 Diagnosis

Koo YJ et al. Maxillomandibular arch width differences at estimated centers of resistance: comparison between normal
occlusion and skeletal Class III malocclusion. Korean J Orthod. 2017
Treatment

• Device v.s. surgery

• Anchorage: tissue, tooth, bone
 Treatment

Stage Procedure
Primary and Early Mixed Dentition Slow expansion with active lingual arch
Late Mixed Dentition Fixed jackscrew appliance
Early Permanent Dentition Fixed jackscrew appliance
Bone anchored device
 Treatment

Stage Procedure
Primary and Early Mixed Dentition Slow expansion with active lingual arch
Late Mixed Dentition Fixed jackscrew appliance
Early Permanent Dentition Fixed jackscrew appliance
Bone anchored device
 Treatment

Stage Procedure
Primary and Early Mixed Dentition Slow expansion with active lingual arch
Late Mixed Dentition Fixed jackscrew appliance
Early Permanent Dentition Fixed jackscrew appliance
Bone anchored device

• remain in place until the new bone formed and calcify

• tooth-supported retainer for another 6 to 12 months
Effect
Effect
 Effect
• Skeletal maturation patient:
• Dental change, skeletal change
• complication 

Sugical assisted RPE

 Treatment

• Chamberland :
• Relapse in dental expansion was almost totally attributed to
lingual movement of the posterior teeth
• 64% of the patients had more than 2 mm of dental changes.

Chamberland, S., & Proffit, W. R. (2011). Short-term and long-term stability of surgically assisted rapid palatal expansion
revisited. American Journal of Orthodontics and Dentofacial Orthopedics
 Treatment

• Kee-joon, Lee
• Hyrax-type

Kee-Joon Lee et al. Maxillary transverse expansion in adults: Rationale, appliance design, and treatment outcomes Seminars
in Orthodontics 2018
 Treatment

Kee-Joon Lee et al. Maxillary transverse expansion in adults: Rationale, appliance design, and treatment outcomes Seminars
in Orthodontics 2018
 Treatment

Kee-Joon Lee et al. Maxillary transverse expansion in adults: Rationale, appliance design, and treatment outcomes Seminars
in Orthodontics 2018
 Treatment

• Won Moon
• MSE

Islam Elkenawy et al. An assessment of the magnitude, parallelism, and asymmetry of micro-implant-assisted rapid
maxillary expansion in non-growing patients Progress in Orthodontics 2020
 Treatment

Carlson, C et al. Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary
deficiency in an adult. AJODO 2016
 Treatment

Carlson, C et al. Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary
deficiency in an adult. AJODO 2016
 • ANS: 4.98 mm
• PNS: 4.77 mm
• 16/31 samples: asymmetry
expansion

Islam Elkenawy et al. An assessment of the magnitude, parallelism, and asymmetry of micro-implant-assisted rapid
maxillary expansion in non-growing patients Progress in Orthodontics 2020
Conclusion
Thank you for your attention