3. โAn orthopedic procedure which uses a
fixed or removable appliance to separate
the two maxillary bones at the mid-palatine
suture.โ
4.
5.
6. 1. stage A, straight
high-density
sutural line, with
no or little inter
digitation. early
childhood; 5-11yr
2.stage B,
scalloped
appearance of the
high-density
sutural line; 13 yr
3.stage C,
2 parallel,
scalloped, high-
density lines that
were close to each
other, separated in
some areas by
small low-density
spaces. Timing
critical for RME
4.stage D, fusion
completed in the
palatine bone,
with no evidence
of a suture. 14 yr
male, 11 yr female
5.stage E, fusion
anteriorly in the
maxilla.
Five stages of maturation of the mid palatal suture
Ref:-Angelieri et al. Am J Orthod Dentofacial Orthop. 2013 Nov; 144(5): 759โ769.
7.
8.
9. 1. The transverse growth was completed for the majority of measurements for both males and females by age 18
years. Each of the measurements was complete by over 80% by age 6 years relative to the size at 18 years. Nasal
width was an exception that was only 75% complete by 6 years of age.
2. Statistically significant differences were found between male and female measurements: at age 6 years, between
mean width of cranium, face, and maxilla; at age 12 years, the differences were between cranial width, maxillary
width, and maxillary-mandibular intermolar(6-6) widths; at age 18 years, all variables were different, except the
nasal width and mandibular intermolar (6-6) width.
3. In females, the cranial and facial width spurts were at 8 years and nasal width was at 11 years. In males, the
cranial width growth spurt was at 12 and 14 years, facial width was at 7 and 15 years, and nasal width spurt was at
10 and 17 years. No growth spurts in the maxillary and mandibular widths for females were recorded.
4. Transverse growth of the face is near complete by age 18 years, although, nasal width still shows growth
increments. As growth in the width of the maxilla and the nose largely occurs between 7 and 11 years of age,
patients requiring orthopedic expansion of the maxilla may be treated with advantage during this period.
5. Linear regression analysis at 6 years revealed strong predictability in both genders for cranial width, facial width,
and mandibular width. The predictability was only moderate for nasal width and maxillary width. However, at age
12 years, the predictability for all craniofacial and dentoalveolar transverse measurements was strong.
10. History
๏ผ E. C. Angell
๏ผ McQuillen (1860) and Coleman (1865)
๏ผ Haas
11. different degrees of occlusal disharmony; airway resistance
changes in tongue posture;
functional shift of the mandible due to incorrect
buccolingual tipping of posterior teeth;
asymmetric mandibular position in growing
patients;
damage to periodontal structures, such as local
bone loss and gingival recession;
joint disorders and muscle function disturbances;
lack of space in the arch for adequate dental alignment.
12. discomfort at the regions of
incisors or nasal suture
ulceration or necrosis of the palatal
mucosa.
There might be some swelling at the
midpalatal suture, particularly soon
after expansion.
Ischemia and necrosis of the palatal
mucosa might occur when the suture
does not yield to forces applied by
the tooth-mucosa-supported
appliance.
The mucosal lesion resulting from
decreased blood low โ caused by the
resultant force โ make the procedure
unfeasible in the event of occurring
before expansion.
13. Effect of rme
Maxillary
skeletal
effect
Palatal
vault
Alveolar
process
Maxillary
anterior
teeth
Maxillary
posterior
teeth
mandible
RME and
nasal
airflow
According to Starnbach et al, palatal
expansion does not only separate the
midpalatal suture, but the circumzygomatic
and circummaxillary sutural systems as well.
Assessment of A point showed a significant
displacement backward.
A point also had an average displacement of
nearly 3 mm downward, but this was not
statistically significant.
Additionally, PNS had an average downward
displacement of about 1 mm, which was not
statistically significant.
14. Who have passed the growth spurt,
Have
recession on
the buccal
aspect
Poor compliance.Convex
profile
Anterior open
bite,
Steep
mandibular
plane,
Contraindication
Midpalatal suture: note that the incisive canal distinguishes
the anterior and middle segments. It goes in posterior and upward direction.
The incisive canal has got vessels, nerves, salivary glands and
nasopalatine canal remnants. The posterior segment is relative to the
suture transversal to the palatal bone
Melsen et al
The following observations may be considered:nanda,2012
If not properly managed within appropriate time, maxillary transverse deficiency, associated or not with posterior crossbite, may result in several problems for the patient:
Figure 7 - When expander is placed at a more posterior position, forces concentrate closer to the pterygoid plates, structures that offer great resistance to palatal
expansion. Therefore, occurs a parallel opening of the palatine suture anteroposteriorly and vertically, differently from conventional expansion, in which opening
takes the form of a "V" (broader in anterior region).
