At the present time no reports are available on the stability between orthopedic and surgically assisted rapid palatal expansion. This study was designed to examine and compare the dental and skeletal changes over time for both orthopedic maxillary expansion and surgically assisted palatal expansion. Bonded hyrax expansion appliances were fabricated for both groups Same dental technician Consistent materials and thickness of each hyrax appliance Same operator, materials, adhesives used for bonding Activation: once a day; 3-4 weeks Retention: “Removable Maxillary Hawley Appliance Retainer” Worn 24 hours/day for 1year before undergoing any additional orthodontic treatment **Inactivated mx expansion appliance was removed for a minimum of 2-3mos before debonding Activation: 4x at a time of surgery and then once a day; 2-3 weeks Retention: Transpalatal Arch **Soldered to maxillary molar bands during the 1 year post expansion period All surgeries performed by means of LE FORT 1 OSTEOTOMY without Down Fracture Involved freeing up the maxilla from buttress and tuberosity areas - To facilitate the effect of orthopedic appliances. The hyrax appliance was expanded four turns during the surgical procedure to verify the extent and symmetry of the expansion.

1. ACHIEVED BY: Dr.Maen Dawodi

2.  At the present time no reports are available
on the stability between orthopedic and
surgically assisted rapid palatal expansion.
 This study was designed to examine and
compare the dental and skeletal changes over
time for both orthopedic maxillary expansion
and surgically assisted palatal expansion.

3. Group 1 Group 2
24 patients 28 patients
14 male; 10 female 12 male; 16 female
Age range: 6 years 8
mos. To 12 years 11mos
Mean age: 8 years 6
mos.
Age range: 13 years
8mos to 35years 1mo.
Mean age: 19 years 3
mos.
Requiring ORTHOPEDIC
EXPANSION OF MAXILLA
SURGICALLY ASSISTED
EXPANSION OF THE
MAXILLA
**** SAME ORTHODONTIST
**** SAME SURGEON

4. Group 1 Group 2
24 patients 28 patients
14 male; 10 female 12 male; 16 female
Age range: 6 years 8
mos. To 12 years 11mos
Mean age: 8 years 6
mos.
Age range: 13 years
8mos to 35years 1mo.
Mean age: 19 years 3
mos.
Requiring ORTHOPEDIC
EXPANSION OF MAXILLA
SURGICALLY ASSISTED
EXPANSION OF THE
MAXILLA
**** SAME ORTHODONTIST
**** SAME SURGEON

5.  Bonded hyrax expansion appliances were
fabricated for both groups
Same dental technician
Consistent materials and thickness of each hyrax
appliance
Same operator, materials, adhesives used for bonding

6. Activation: once a day; 3-4 weeks
Retention:
“Removable Maxillary Hawley Appliance Retainer”
Worn 24 hours/day for 1year before
undergoing any additional orthodontic
treatment
**Inactivated mx expansion appliance was
removed for a minimum of 2-3mos
before debonding

7. Activation: 4x at a time of surgery
and then once a day; 2-3 weeks
Retention: Transpalatal Arch
**Soldered to maxillary molar bands
during the 1 year post expansion period

8.  All surgeries performed by means of LE FORT 1
OSTEOTOMY without Down Fracture
 Involved freeing up the maxilla from buttress and
tuberosity areas
- To facilitate the effect of orthopedic appliances.
 The hyrax appliance was expanded four turns
during the surgical procedure to verify the
extent and symmetry of the expansion.

9.  Posterior-Anterior Cephalograms (PA)
 Alginate impressions for dental models
 After expansion,
◦ 2nd PA cephalogram
*impressions and PA cephalograms were taken at
time of debonding the expansion appliance, and a
year after removal of retention appliance
*** PA ----- same machine
*** Models ----- same technician

10.  Interoperative reliability test was performed
 Intermolar width was performed
 Intercanine width was measured
 All measurements were recorded to the tenth
of a millimeters

11. Intermolar width
Intercanine width

12.  PA cephalograms were analyzed with Linear
measurements:
◦ Maxillary width (R-L Mx to Mx1)
 For surgical – located through or below the
osteotomy line
◦ Frontal Facial Plane:
 Line connecting greater wing of sphenoid and
orbit (LO-LOI) to the antegonial notch of the
mandible
 (Go-Go1)
◦ Relative R-L Mx to Mn Widths:
 Mx pt to frontal facial line

13.  Facial Width:
◦ Distance R-L most lateral points of zygomatic
arch (Zy-Zy1)
 Nasal Floor:
◦ Widest portion of inferior area of Nasal
Opening(N-N1)
 Interalveolar width:
◦ R-L intersection of alveolus and mx molars

14. Mean Values and standard deviations were
examined to compare linear changes both within
and between groups
A repeated measures analysis of variance (ANOVA)
design was applied to assess changes over time for
each of the surgical and orthopedic groups.

16. FACIAL WIDTH
MAXILLARY WIDTH
INTERALVEOLAR WIDTH
NASAL FLOOR
FRONTAL
FACIAL
PLANE
FRONTAL
FACIAL
PLANE

17.  26 surgically assisted and 24 orthopedic
expansion patients were examined

18. Orthopedic
Expansion
Surgically
Assisted
Canine
Intercanine
Group
>4.22mm
end of
expansion
<1.03mm
after a
year
>4.84mm
after
surgery
<1.2mm
after a
year
Before tx Surgical >orthopedic
1.5mm
After surgery, >
0.66mm
Molar
Intermolar >4.69mm
After
expansion
<0.3mm
after a
year
>5.78mm
after
surgery
<1.01 mm
after a
year
****Orthopedic showed greater stability than surgical group

19.  The orthopedic group showed greater
stability with a decrease of only 0.3 mm,
 The surgical group had an intermolar
decrease of 1.01 mm during retention.

20. Orthopedic Surgical
Alveolar Measurements
(Ma-Ma1)
>4.29mm during
active expansion
>0.56mm after
removal
<0.28mm 1yr
retention
>3.42mm
>0.78mm after
removal
<0.14mm 1yr
retention
Maxilla (Mx-Mx1) >3.54mm after
removal
>0.5 inactive period
<0.37mm 1yr
retention
>3.0mm completion of
expansion
<0.67mm 1yr
retention

21.  Alveolar Measurements
the orthopedic and surgical procedures
showed approximately the same degree of
alveolar stability during the following 12 months
of retention with the orthopedic treatment group
decreasing only by 0.14 mm more than the
surgical treatment group.
 Maxilla (Mx-Mx1)
Both groups showed roughly the same
stability with decreases of 0.69 mm in the
orthopedic group and 0.67 mm in the surgical
group during the 1-year retention period.

22. Zygomatic Width
(Zy- Zy1)
>0.81mm onset of tx
to cessation of
expansion
<0.29 mm fixation –
before removal
>1.91mm 1-year
retention
>0.53mm onset of tx
to cessation of
expansion
>0.16mm fixation –
before removal
>0.47mm 1yr
retention
Nasal (N-N1) >1.67mm during
expansion
<0.09mm fixed to
removal
>0.47 1yr retention
>1.72mm during
expansion
<0.41mm fixed to
removal
<0.14 1yr retention
Orthopedic Surgical

23.  Zygomatic Width (Zy- Zy1)
The orthopedic group showed almost four
times the mean increase with a value of 1.91
mm, and the surgical group increased only
0.47 mm creating a 1.44 mm difference
between the groups

24.  Significant changes were noted in both the
initial measurements and the post expansion
measurements between the two groups.
 The initial measurements were found to be
larger for the surgical patients
 The differences noted in the initial pre-
expansion measurements between the two
groups were due to the difference in skeletal
age or facial size

25.  During treatment and retention,
◦ surgically expanded group:
 exhibited an increase in zygomatic width of 1.16 mm
◦ orthopedic group:
 total mean increase of 2.43 mm

26.  Bishara et al,
◦ noted a mean increase of 1 mm per year of growth
in zygomatic width,
----------which could possibly explain the
difference between the start and end of retention
measurements 1 year later between the two groups

27.  Upper parts of the midface are affected by
surgically assisted rapid palatal maxillary
expansion.
 The very slight increase (0.016 mm) observed
during the stabilization phase could possibly
be attributed to measurement error.

28.  In both groups were different in size at the
beginning of treatment and each displayed a
similar change of 2.0 mm during treatment.
 Increase in width during the retention phase of both
groups.

29.  There is no difference in the stability of
surgically assisted rapid palatal expansion
and nonsurgical orthopedic expansion.
 There was a significant difference in the
amount of expansion between groups for
intercanine and intermolar widths as well as
interalveolar distance

30.  There were no other statistical differences
when examining any of the landmarks over
time.
 There was no statistical significance between
time versus group, time, or group
membership
 no difference in behavior between the two groups