2. The palate orthopedic expansion is indicated in those cases that present a contraction of the transverse diameter of the maxilla in children and youth up to age 15-16 years, where you need to resolve a discrepancy of more than 5mm cross. This procedure is used in preference to bilateral cross-bite cases, but also in patients with cleft lip-palate with inhibition of growth of the maxilla. Summary
3. Treatment is the disjunction of the palatal suture, so that expansion can take place parallel to the two segments cross. Thanks to treatment, not only broadens the base of the upper jaw, but also extends the floor of the nasal passages and thus eventually achieved improvement of ventilation. Objective
4. The palate orthopedic expansion is an intervention performed many years ago and The importance of these breakers without surgical intervention to correct the contractions of the transverse diameter of the maxillary defect associated with the base skeletal pathology that often can be found and with increasing frequency in malocclusion Class I, II or III. Importance
5. There are several kinds of circuit breakers and in turn changes therein. The circuit breaker is between HYRAS faster or more devices used in the field of dento-maxillary orthopedics. Among the advantages we have.1. Little need for patient cooperation.2. Extreme strength.3. Precise time of therapy, orthopedic outcomes in patients who are still finalizing their growth.4. Modifications of mandibular posture.5. Better breathing.
6. The disjunction of the palatal suture is a method of treatment described in 1860 by Angle, who achieved mechanically forced expansion of the median palatine suture The palate orthopedic expansion, and consequently the circuit breaker, is indicated in cases of maxillary endognasia. Endognasia jaw means a contraction (collapse maxillary), sometimes, it is only necessary a careful morphological and functional evaluation during the first appointment. In these cases, we observe the formation arched palate, which is developed more in height. Disjunction PALATINE
7. Despite the obvious morphological and functional problems present, could remain in doubt that the contraction of the arch is dentoalveolar and basal. It is possible to confirm the differential diagnosis in the previous posterolateralTeleradiograph. The radiographic projection will show whether the axes lobby palatine upper and lower molars are or are not aligned. In the first case it would be endognasia in the second endoalveolia (Fig. 1). Figure 1
8. The presence of a maxillary transverse failure is often the result of a posterior crossbite (cross bite) that can be mono or bilateral. When it occurs bilaterally, the image must be respected, more commonly, argues a narrower maxilla with respect to smaller (Fig. 2). The jaw may be well placed in central position with respect to the skull and therefore there will be no noise in the temporomandibular joint (click). (Fig. 2).
9. If monolateralcrossbite is often it is a hiccup on transverse expansion, determining prematurities cusps and, hence, a lateral shift of the mandible (Fig. 3). (Fig. 3)
10. For this reason, the jaw is not located centrally with respect to the skull;This functional malposition can trigger structural.This would cause a negative orthopedic effect, capable of producing a deformed jaw structure. In some cases, a figure much lower, the clinical picture is similar, but it is a monolateral constraint so a correction must be made monolateral (Fig. 4). (Fig. 4).
11. Before starting the therapy is necessary to assess the situation of the mandible. The occlusion can present three different situations:1. No crossbite2. Monolateral crossbite3. Bilateral crossbite JAW SITUATION
12. When the patient is still growing, or is young, the lateral shift is much more common. In these cases, during the consultation must be established if there are contacts in centric relation premature. Semiological these maneuvers are: 1. Trying to close in centric position (carefully manipulate the jaw) to see if there prematurities diverters 2. Make the most open and check if the median lines focus 3. Make protrude the most and see if the media focused lines 4. Palpate the lateral pterygoid muscle highlighting a possible nuisance monolateral
13. The stitches that bind the jaw with the other craniofacial bones react before the forces, but their resistance makes the action level is tested in Palatine. Breaker orthopedic effects are manifested in different planes: horizontal, frontal and sagittal planes. EFFECTS skeletal and dental
14. On the horizontal plane happens fanning the average palate suture determined by the increasing resistance of the posterior. At this point, the transverse dimension is maintained by the pterygoid processes which, being of endochondral origin, represent structures are difficult to alter with therapy (Fig. 5). (Fig. 5)
15. In the frontal plane, the two jaws diverge down in a pyramidal movement (Fig. 6). In this rotation is going out also, the decline in the vault, through which it occurs increase nasal ventilatory capacity (Fig. 7). (Fig. 7) (Fig. 6)
16. After the first days of activation, one can observe the presence of a diastemainterincisal is a clear sign of the presence of disjunction. After 30-40 days, the diastema was closed by mutual pull of transseptal fibers between the two central incisors. This closure, initially, is only at the level of the crowns, because the roots are still in dispute, each located on one side of the suture is still open. Only at the end of containment, the two central regain their natural inclination, including at the root (Fig. 8).
18. For this kind of disjunction device is used, the same bearing in the center a special screw (screw type HYRAS). Generally, this screw is welded to bands Hyras premolars and molars. In case of patients with completely deciduous teeth, the device is anchored in the second temporary molar and the canine (Fig. 9). (Fig. 9)
19. The dental braces are also located on the second permanent molars and canines, the important thing is not involved in anchoring the lateral and central. Expansion bolts are the four arms bent and cut so they can be welded to the bands. There are bolts of various sizes, according to the expansion that is desired, the larger the greater the expansion screw that can be done.
20. The force transmitted to the screw to open a circuit breaker is of a certain intensity, but only applies dental cause a moderate inclination The activities will depend on how much we need to expand across the maxilla. Usually it is the parents who open the screws.timely notify parents that after a certain number of activations, interincisivediastema appears to enable them to interpret this sign, in a positive way
21. Containment has a duration of at least four months. The breaker does not work, obviously, if the palate orthopedic expansion is impossible. This happens when the relationship between the resistance of the anchor (teeth) and the suture is no longer favorable. The causes unfavorable escalation of suture ossification (depending on patient age) and periodontal conditions involved
22. BIBLIOGRAFIA 1. Hart A., Taft L., Grenberg S.N.: “ The effectiveness of differential moments in establishing and mainteining anchorage”. Am. J Orthod. DentofacialOrthop. 102:34-42,1992. 2. Harvold E. P.: “ Neuromuscula and morphological adaptations in experimentally induce oral respiration”. In McNamara, J. A. Jr. (ed): Naso-repiratory Function and Craniofacial Growth. Monograph 9, Craniofacial Growth Series, Center for Human Growth and Development, The University of Michigan, Ann Arbor, 1979. 3. McNamara J. A., Brudom W.; Trattamentoortodontico e ortopedico in dentadura mista. Masson, Milano, 1988. 4. Petrovic A., Stutzmann J.; “Le musclepteérygoidien externe et la croissance du condylemandibulaire. Recherchesexpérimentaleschez le jeunerat”. Orthod. Fr. 43(1):271-286,1972. 5. Bell RA (1982) A review of maxillary expansion in relation to rate of expansion and patient’s age. Amer J Orthodont 81:32. 6. Adkins MD, Nanda RS, Currier FG, Arch perimeter changes on rapid palatal expasion. Am J OrtodDentofacOrthop 1990; 97:194-9. 7. Hass AJ. Palatal expasion: just the beginning of dentofacial orthopedics. Am J Orthod 1970; 57; 219-55 8. Angle EH (1913) Die OkklusionsanomalienderZähne. 2. Aufl., Meusser, Berlin
