Rme slide /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call

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Rme slide /certified fixed orthodontic courses by Indian dental academy

  1. 1. GOOD MORNING www.indiandentalacademy.com
  2. 2. RAPID MAXILLAR Y EXPANSION INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  3. 3. INTRODUCTION • Word “Expansion” refers to lateral enlargement of dental arches by orthodontic forces which can be either direct (or) indirect. • Direct forces - Exerted against the teeth to move them in a buccal direction • Indirect forces - through the pull at the interseptal fibres.www.indiandentalacademy.com
  4. 4. • First objective in orthodontic treatment - Correction of discrepancy in transverse dimension. • This can be achieved by carrying out the procedure called “Rapid Maxillary Expansion” www.indiandentalacademy.com
  5. 5. Historical Background: • Narrow maxilla - recognized thousand of yrs ago in Hippocrates. • No scientific treatment possible as comparable to present day. • Before RME, a number of slow expansion techniques were used by early practitioners. • Fauchard (1728), Bourdent (1757), Fox (1830), Delabarre (1819), Lefoulon (1839 Tomes (1848), Allen (1850), White (1859) & Westcott (1859).www.indiandentalacademy.com
  6. 6. • R.M.E. - Not evolved from above mentioned slow expansion technique. • In Sanfrancisco in 1860 Emerson C. Angell placed screw appliance between max. Premolars - girl aged 141 /2 yrs - provided with key - instructed to keep shaft as tight as possible. • At end of 2 weeks - jaw widened - space between two front incisors. • But this bold statement could not be proved with radiographs as x-rays still to be discovered.www.indiandentalacademy.com
  7. 7. • Angell’s article - stressed importance of per. I. molars and found alternative in absence of per. I. molar with double jack screw with opposing threads. • Angell work published in Sanfranciso medical press as “The permanent or adult teeth”. • In dental cosmos as “Treatment irregularities of permanent or adult teeth”.www.indiandentalacademy.com
  8. 8. • Angell depressed because one of his diagrams was published with central incisors together - instead of showing median diastema. • This makes Angell’s future silence & RME more than a generation. www.indiandentalacademy.com
  9. 9. • After 5 yrs a reference was made by A. coleman 1865) this inspired Dr.Coffin to invent a spring for widening the arch. • Latter in 1893 professor clarke L. Goddord used an appliance with bands and a jack screw and claimed the maxillary separation. • G.V. Black in 1893 expanded the dental arch by rapid means using split plates and jack screws.www.indiandentalacademy.com
  10. 10. • Now great debate was started between rapid and slow techniques. • E.H.Angle (1910), V.H. Jackson (1904, 1909) & A.H.Ketcham (1912) stood for slow expansion while C.H. Hawley (1912), H.A. Pullen (1912) & M. Dewey (1913, 1914) opted for RME. www.indiandentalacademy.com
  11. 11. • A slow epander’s claimed improved oral hygiene by using bands with arch wires instead of plates with screws, which covered the palatal mucosa and the heavy forces necessary for RME. • Rapid expanders were not sure of the extent of the opening of the suture or the general effect. • Moreover rapid expanders are mostly oral surgeons not orthodontists. www.indiandentalacademy.com
  12. 12. • M.H. Cryer (1913), an influential anatomist who considered that the mid palatal suture could not be opened because of the buttressing and circum maxillary structures. • This makes set back for R.M.E. after a generation gap R.M.E. reawakened by G.Korkhaus in 1958). www.indiandentalacademy.com
  13. 13. ANATOMY Bones • Maxilla - 2nd largest facial bone. • Unites with its opposite twin forms whole of upper jaw. • They form root of mouth, floor and lateral wall of nasal cavity and floor of orbit. • Enter into formation of Infratemporal fossae, inferior orbital and pterygo maxillary fissures. www.indiandentalacademy.com
  14. 14. Various bones articulates with maxillae are Cranial Facial 1. Frontal 1. Nasal 2. Ethmoidal 2. Lacrimal 3. Inferior nasal concha. 4. Vomer 5. Zygomatic 6. Palatine 7. Opposite maxillaewww.indiandentalacademy.com
  15. 15. • These bone joins maxilla by suture in posterior and superior aspect. Leaving anterior inferior aspect free. • The tenacity of circummaxillary attachments due to buttressing is strong postero-supero-medially and postero supero laterally. • Palatine bones forms an intimate relationship with maxilla to form complete hard palate (or) floor of nose and greater part of lateral wall of nasal cavity. www.indiandentalacademy.com
  16. 16. • It articulates anteriorly with maxilla through transverse palatal sutures and posteriorly through pterygoid process of the sphenoid bone. • The interpalatine suture joins the two palatine bones at their horizontal plates and continous as inter maxillary sutures. • These sutures forms the junction of three opposing pairs of bones : the premaxillae, maxilla, and the palatine. • The entire forms mid-palatal suture.www.indiandentalacademy.com
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  18. 18. • The maxillae is in an exposed position, supported at only part of its circumference and is vulnerable to lateral displacement especially the anterior and inferior portions, once the mid- palatal suture has been ruptured. • Hence bilateral displacement is relatively easy when the force is applied on the teeth, which is deeply rooted in the alveolar process of the maxillae. www.indiandentalacademy.com
  19. 19. SUTURES • MPS - Plays a key role in R.M.E. Melsen (1975) - histological feature. i. Infancy - Y-shape ii. Juvenile - T-shape iii.Adolescence - Jigsaw puzzle • As sutural patency is vital to R.M.E, it is imp. To know when does the suture closes by synostosis. www.indiandentalacademy.com
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  21. 21. • Persson et al (1973, 1976 & 1977) found the rate of ossification & Onset. From his study, the following points are taken. – Earliest closure in girls aged 15 yrs. Oldest unossified suture -women 27 yrs. – Bony spicules appear between age 15 yrs & 19 yrs. – Greater degree of obliteration occurs posteriorly than anteriorly. – On average 5% of suture in closed by age 25 yrs. www.indiandentalacademy.com
  22. 22. • If it is accepted that 5% of sutural closure, can be broken without surgical assistance then average age of 25 yrs used only as general guide. • Ossification comes very late anterior to incisive foramen - this is imp. When planning surgical freeing in late instances of RME. www.indiandentalacademy.com
  23. 23. • RME - used from 3-35 yrs of age. • Younger age - assessing te growth potential & retention is difficult. • Older age - Discomfort and pain is experienced. • Best time - 10 & 15 yrs. But the child may complain of feeling tension across the floor of nose which disappears after 2-3 days.www.indiandentalacademy.com
  24. 24. Factors to be considered prior to expansion • Discrepancy between max of mand 1st molars & bicuspid width is 4mm or more RME indicated. • Severity of cross bite • Initial angulation of molars or premolars • Assessment of roots of decidious tooth • Physical availability of space for expansion.www.indiandentalacademy.com
  25. 25. R.M.E. Depends on • Rate of expansion – Expansion of dental arch increases as rate of expansion is increased. • Form of expansion – Effect of expansion increases as rigidity is increased • Age of patient – Effect of expansion diminishes as age advances.www.indiandentalacademy.com
  26. 26. BANDED R.M.E. • Derichsweiler type – I premolars and I molars are banded – wire tags are soldered onto palatal aspect of bands. – Wire tags get inserted into split palatal acrylic plate with screw at its centre. www.indiandentalacademy.com
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  28. 28. HAAS TYPE • I premolar and molar of either side banded. • 0.045 inch (1.15mm) length SS wire is welded and soldered in buccal and palatal aspects of bands. • Lingual wire is kept long and extend anteriorly and posteriorly. • Extension - bent palatally and embedded in palatal acrylic. • Split palatal acrylic has midline screw. Plate does not extend over rugae area. www.indiandentalacademy.com
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  30. 30. ISAAC SON TYPE • Tooth borne appliance • spring loaded screw - MINNE expander (Developed at university of Minnesota Dental school). • I premolars and molars banded. • Metal flanges - soldered to bands - buccal and lingual sides. • Coil spring made to extend between the lingual metal flanges. • Activated by closing the nut. www.indiandentalacademy.com
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  32. 32. HYRAX TYPE • Use of special type of screw HYRAX (Hygienic rapid expander) • Screws have heavy gauge wire extensions adapted to fallow palatal contour and are soldered to bands on premolars and molars. www.indiandentalacademy.com
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  34. 34. Bonded R.M.E • Alternative design - splint covering variable number of teeth on either side to which the jack screw is attached. • Splints - 2 types – Cast cap - silver copper alloy – Acrylic - polymethyl - metheracrylate. • Splints are bonded - GIC - after adequate etching. www.indiandentalacademy.com
  35. 35. Description of a typical expansion screw • Consists of long body divided into two halves. • Each half has threaded inner side that receives one end of a double ended screw. • Screw has central bossing with four holes. • Turning of screw -90 degree (ie.) one turn brings about in linear movement of 0.18 mm. www.indiandentalacademy.com
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  37. 37. Cementation of Appliance • Ames black copper cement is best • Good adhesive and has germicidal property - assists oral hygiene • mixed on glass slab with SS spatula • generous film is applied to dried internal surface of cap splints • max. teeth dried - appliance is pressed firmly into position • setting time for cement is 20-30 seconds • excess cements removed by scalers.www.indiandentalacademy.com
  38. 38. Activation schedule • Various authors advocated different activation schedules. Schedule by Timms: • Up to 15 yrs - 900 rotation in morning & evening. • Over 15 yrs - 450 activation 4 times a day. www.indiandentalacademy.com
  39. 39. Schedule by Zimring & Isaacson: • Young growing patients - 2 turns each day for 4- 5 days & later one turn/day till desired expansion achieved. • Non growing adults - 2 turn each day for first 2 days, one turn/day for next 5-7 days and one turn every alternate day till desired expansion is achieved. www.indiandentalacademy.com
  40. 40. Schedule by Bishara: • Young adults - 3 mm first week & 1.75 mm each week there after. • Older adolescents - 2.2 mm first week, 1.75 mm 2nd week & 1.0 mm each week there after. www.indiandentalacademy.com
  41. 41. Effect of R.M.E Maxillary Skeletal Effect • Opening of mid - palatal suture is fan shaped or triangular with minimum opening at the incisor region. • Similar fan shaped opening is also seen in superio-inferior direction. • Max. opening - towards oral cavity .less opening - towards nasal aspect. www.indiandentalacademy.com
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  43. 43. • According to krebs - two halves of maxilla rotate in sagital & coronal planes. • In coronal plane - two halves of maxilla rotate away from each other. • The point at which rotation takes place is around fronto max. Suture. • Sagittal plane - maxilla found to rotate in downward and forward direction.www.indiandentalacademy.com
  44. 44. AMOUNT OF EXAPNSION ACHIEVED • An increase in maxillary width of upto 10 mm can be achieved by R.M.E. • Rate of expansion is 0.2 to 0.5mm per day. EFFECT ON ALVEOLAR BONE • Alveolar bone in area adjacent to anchor teeth bends slightly. This is due to resilient nature of alveolar bone. www.indiandentalacademy.com
  45. 45. EFFECTS ON MAX ANTERIOR TEETH • App. Of midline spacing is most reliable clinical evidence max. separation. • Incisor sep. is half of distance the screw is opened. • By 3-5 months midline diastema closes as a result of trans - septal fibre traction EFFECTS ON MAX POSTERIORTEETH • Teeth show buccal tipping and believed to extrude to limited extent www.indiandentalacademy.com
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  47. 47. Effect of Mandible: • Downward & Backward rotation • Slight increase in mandibular plane angle. • Reason for mandibular rotation is extrusion & buccal tipping of max. Molars. Effect on adjacent cranial bones & sutures: • Bones of cranium such as parietal & occipital were also found to be displaced. www.indiandentalacademy.com
  48. 48. Effect of R.M.E. on nasal cavity: • Increase in inter nasal space. • Increase in nasal cavity width is max. in inferior region and decreases in superior region of nasal cavity. • Similar gradient is also found in an anterio- posterior direction with greatest increase being in anterior region. www.indiandentalacademy.com
  49. 49. Retention: • Objective of retention is to hold the expansion, while all those forces generated by expansion have decayed away. • Basis for holding teeth in treated position is to – Periodontal or gingival reorganisation – Permit neuro muscular adaptation to corrected tooth position. – To maintain unstable tooth positionwww.indiandentalacademy.com
  50. 50. • According to krebs (1964) Timms (1976), 5 yrs of retention period is required. • The first removable retention plate consists of base plate of cold cure acrylic with 4 adams cribs. • This allows max. time for recovery and opportunity for relapse. • Isaacson recommends the use of RME appliance for retention. www.indiandentalacademy.com
  51. 51. • The further the teeth moved laterally and more rapidly, the longer should be period of retention • if arch widened over short period of time with more rapid teeth. Chances of relapse is more and hence over expansion is advised. www.indiandentalacademy.com
  52. 52. COMPARISON OF TREATMENT OUT COMES WITH BANDED AND BONDED R.P.E. APLIANCES (AJO-1999) • Purpose – compare treatment outcomes with banded versus bonded R.P.E. • Banded R.P.E – had more vertical change • Most of these changes less than 10 or 1mm • This study could not establish superiority of one type of R.P.E. teeth over another. www.indiandentalacademy.com
  53. 53. SURGICAL ASSISTED R.M.E.: ORTHODONTIC PREPARATION FOR CLINICAL SUCCESS (AJO – 1999) • Close root proximity between max central incisors presents a problem in surgical management of R.M.E. • During surgical fracture of Inter dental area – separation occur between root surface and bone. • Asymmetric separation places more stress on mesial gingival attachment. • Gingival detachment – epithelial downgrowth – prevents bone apposition in a coronal direction.www.indiandentalacademy.com
  54. 54. • Osseous defect - difficult to treat with osseous graft procedure. • Treatment plan - Analysis of a recent periapical radiograph of incisor roots - to determine the need for orthodontic root separation before surgery. • Post surgical radiograph - taken to determine where the interdental separation has occurred. • Expansion schedule should be adjusted depending on symmetry of separation and health of gingival attachment. www.indiandentalacademy.com
  55. 55. TREATMENT AND POST TREATMENT CRANIOFACIAL CHANGES AFTER R.M.E AND FACE MASK THERAPY (AJO-2000) • Aim to evaluate treatment and post treatment dento skeletal changes in early and late mixed dentition patients. • The result of this study was • Increase in sagittal growth of maxilla - enrly mixed dentition • Backward positional rotation of mandible with increase in lower anterior facial height - late mixed dentition • Relapse tendency affects • Sagittal growth of maxilla - early • Sagittal growth of mandible - late dentition. • More favourable craniofacial changes - early dentition.www.indiandentalacademy.com
  56. 56. LONG TERM EFFECTS OF R.M.E. (AJO – 2000) • Aim - investigate long term effects induced by R.M.E. followed by comprehensive orthodontic treatment. • R.M.E - Edgewise appliance therapy - increase transverse facial dimensions • Pre treatment deficiencies also corrected. • Initial deficiency in latero-orbital width also eliminated. www.indiandentalacademy.com
  57. 57. Comp. Of Dental and D.A. changes between R.P.E. & Nickel titanium palatal Exp. Appliance. (AJO – 2001) • This study show Both RPE and niti expanders - expands max. dentition, alveolar process and corrects posterior cross bites. MPS separation was less obvious - Niti group. No correlation between age and D.A. exp in either group. More distal molar rotation - Niti group. www.indiandentalacademy.com
  58. 58. A BONDED FUNCTIONAL RAMP TO AID IN ASYMMETRIC EXPANSION OF UNILATERAL POSTERIOR CROSS BITES (AJO – 2001) • Article - describes method for treating unilateral posterior cross bite and lack of CB correction after R.P.E. • Composite ramp is bonded to mesio buccal cusp of max. I Molar in crossbite • This adjunctive procedure requires no more than 5 extra minute. www.indiandentalacademy.com
  59. 59. MAX SAGITTAL AND VERTICAL DISPLACEMENT INDUCED BY SARME (AJO – 2001) • AIM to investigate sagittal and vertical effects on maxilla induced by SARME • SARME - did not significantly affect maxilla vertically. • But induce - slight forward movement of maxilla and slight retroclination of max. incisors sagitally.www.indiandentalacademy.com
  60. 60. EFFECT OF MODIFIED ACRYLIC BONDED RME VERTICAL CHIN CAP. (AJO – 2002) • Aim - sagittal, transverse and vertical effect of R.M.E. With vertical chin cap • Nasal width, max. width, man and max inter molar width, upper molar tipped buccally in both groups (ie.) RME and RME with chin cap. • Position of mandible, lower facial height, position of max. I molar in vertical direction does not change in RME with chin cap. • Conclusoin - chin cap prevent vertical effect of RME. www.indiandentalacademy.com
  61. 61. HISTOLOGIC AND HISTOMORPHOMETRIC EVALUATION OF PULPAL RECTIONS FOLLOWING R.M.E (AJO – 2000) • AIM - investigate effects of pulpal tissue of anchor premolar teeth. www.indiandentalacademy.com
  62. 62. www.indiandentalacademy.com For more details please visit www.indiandentalacademy.com