Surgically assisted rapid maxillary expansion (SARME) is a surgical technique used to widen the maxilla. It involves performing corticotomies through the zygomatic buttress and releasing other resistant structures like the midpalatal suture and pterygoid plates. An expander is placed preoperatively and activated starting 5 days post-op at 0.5mm/day. SARME allows for greater expansion than orthodontics alone and has better stability than segmental osteotomies. It is used to treat transverse deficiencies over 5mm and failed orthodontic expansion in adults. Risks include periodontal damage, root damage, and nasal complications.
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.for more details please visit
www.indiandentalacademy.com
COGS analysis (Cephelometrics for orthognathic surgery) / fixed orthodontics ...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
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.for more details please visit
www.indiandentalacademy.com
COGS analysis (Cephelometrics for orthognathic surgery) / fixed orthodontics ...Indian dental academy
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Used in the right conditions, SFOA is highly successful and has a positive impact on the patients psychosocial status.A combined orthodontic and orthognathic surgery approach is accepted as the standard of care for patients who have a severe skeletal jaw discrepancy with facial asymmetry.
But some disadvantages have been recognized.
One drawback is the long presurgical treatment time that typically worsens facial appearance and exacerbates the malocclusion. In some countries, these disadvantages have caused patients to seek plastic surgeons who are willing to perform orthognathic surgeries without collaboration with orthodontists or consideration for the final occlusion.
Recently, to address patient demand and satisfaction, the surgery-first approach was introduced to overcome some disadvantages associated with the conventional surgical orthodontic approach.1991-Brachvogel et al. suggested the potential advantages of a surgery-first approach.
In that article the advantages of post-surgical orthodontics are outlined as follows:
1) Orthodontic movement does not interfere with compensatory biological responses.
2) Dental movements can be based on an already corrected skeletal pattern.
3) Some surgical relapse can be managed during treatment.
2009: Nagasaka et al., popularized SFOA54. Nagasaka et al1 were among the first to actually carry out SFOA using miniplates for post-surgical orthodontic treatment
The 2011 symposium presented the surgery‑first approach and created broader interest in the complete elimination of time‑consuming preoperative orthodontic treatment
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
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.for more details please visit
www.indiandentalacademy.com
Description :
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.for more details please visit
www.indiandentalacademy.com
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
indications and contraindications of rapid maxillary arch expansion,appliances used and effects of rapid maxillary arch expansion/ comparison between rapid and slow expansion
The treatment of maxillary transverse deficiency in post-pubertal patients has been an area of disagreement among orthodontists. Much of the controversy is over the timing of when it is appropriate for these patients to be referred to an oral and maxillofacial surgeon for an adjunctive surgical procedure or whether traditional orthodontic mechanics should be attempted. The decision, therefore, by an orthodontist of when to refer a patient for surgery
appears to be an individual one. The question then becomes which of the three basic surgical procedures would be most appropriate for the patient. Specifically, consideration must be given to surgically assisted rapid palatal expansion, segmental LeFort I osteotomy, or mandibular midline osteotomy with constriction.
Indications of orthognathic surgery and surgical proceduresMaherFouda1
this explains indications of performing orthognathic surgery.It also explains different surgical procedures for different severe forms of malocclusion .
Rapid maxillary expansion in orthodontics / dental crown & bridge coursesIndian dental academy
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.for more details please visit
www.indiandentalacademy.com
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Description :
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.for more details please visit
www.indiandentalacademy.com
The maxillary sinuses were first illustrated and described by Leonardo Da Vinci in 1489 and later documented by the English anatomist Nathaniel Highmore in 1651.
The maxillary sinus, or antrum of Highmore, lies within the body of the maxillary bone and is the largest and first to develop of the paranasal sinuses.
Shape- a pyramid-shaped cavity; base- adjacent to the nasal wall; apex- pointing to zygoma.
Size- insignificant until eruption of permanent dentition; average dimensions of adult sinus- 2.5–3.5 cm wide, 3.6–4.5 cm tall, and 3.8–4.5 cm deep; estimated volume of approximately 12–15 cm.
Extent- Anteriorly, extends to canine and premolar area. sinus floor usually has its most inferior point near the first molar region.
How to gain space
For General practitioners
Prepared by
Dr. M Alruby
The correction of many malocclusions requires space in order to move teeth into more ideal locations. Space required for correction of: crowding, retraction of proclined teeth, leveling of steep curve of spee, derotation of anterior teeth and for correction of unstable molar relation, the orthodontist is often faced with the dilemma of how to obtain space for these corrections. Planning space is an important aspect of treatment planning.
Methods for gaining space:
1-Proximal stripping.
2-Expansion.
3-Extraction.
4-Uprighting of the molars.
5-Derotation of posterior teeth.
6-Proclination of anterior teeth.
7- Distalization.
1- Proximal stripping:
Proximal stripping is a method by which the proximal surfaces of the teeth are sliced in order to reduce the mesio-distal width of the teeth. It also known by the synonyms, reproximation, slenderization, disking and proximal slicing. Although this procedure is routinely carried out on the lower incisors it can also be done on the upper anterior and buccal segments of upper and lower arches.
Indication for proximal stripping:
1- Proximal stripping is usually indicated when the space required is minimal (about 2.5 mm) in these cases, it is possible to avoid extraction of the teeth by performing reproximation.
2- If the Bolton's analysis show mild tooth material excess in either of the arches, it is possible to reduce the tooth material by proximal stripping.
Contra indication for proximal stripping:
1- Proximal stripping is not carried out in young patients, as they possess large pulp chamber, which increase the risk of pulpal exposure.
2- Patients who are susceptible to caries or those have high caries index.
Advantage of proximal stripping:
1- It is possible to avoid extraction in borderline cases where space requirement is minimal.
2- A more favorable over bite and over jet relation can be established by eliminating tooth material excess in either of the arches.
3- More stable results can be established by broadening the contact area thereby eliminating small contact points, which can slip and cause rotation of the teeth.
Disadvantage of proximal stripping:
1- The stripping procedure creates roughened proximal surface that attracts plaque.
2- Caries susceptibility is increased as a part of the enamel is removed, leaving behind a roughened area.
3- Patients may experience sensitivity of the teeth.
4- Improper procedure at the hands of the inexperienced operators can result in alteration of morphology of the teeth, creating an unnatural appearance of the teeth.
5- Loss of contact between adjacent teeth may result in food impaction.
Diagnostic aids for proximal stripping:
Arch perimeter analysis: showing tooth material excess about 2.5 mm over the arch length is a diagnostic criteria favoring reproximation.
Bolton's analysis: Bolton's analysis revealing an excess of tooth material in either of th
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
The POPPY STUDY (Preconception to post-partum cardiovascular function in prim...
Surgically assisted rapid maxillary expansion by Almuzian
1. Surgically assisted rapid maxillary expansion (SARME)
Technique
It is a part of distraction osteogenisis
Most methods consider the zygomaticomaxillary junction the major site of resistance and
perform a corticotomy through the zygomatic buttress from the piriform rim to the
maxillopterygoid junction
The midpalatal suture is historically considered the major place of resistance but this was
proven to be untrue by ISAACSON & INGRAM and KENNEDY et al.. Still many, but not all,
release the midpalatal suture by paramedical cut in order to:
1. Improve mobility and
2. Prevent deviation of the nasal septum to either side and thereby causing changes in nasal flow.
A tomographic study by Schwarz showed no significant change in nasal septum position in
SARME without sectioning of the nasal septum and an increase nasal airway space
The pterygoid plates are also a considerable site of resistance but because of the increased risk
of injuring the pterygoid plexus by the osteotomy, some chose not to, without loosing much
mobility. By not releasing the pterygoid junction, the pattern of opening of the maxillary halves
is more V-shaped.
An investigation by Shetty and coworkers attempted to give a biomechanical rational for the
choice of osteotomies by analyzing the internal stress response after SARME in a photoelastic
model fabricated from a human skull. A Hyrax appliance was placed and activated, and
sequential cuts were performed on the model. The alterations in the internal stresses of the skull
were recorded after each cut. All the bony buttresses of the maxilla contributed resistance to
expansion, but the midpalatal suture followed by the pterygomaxillary articulations were the
primary areas of resistance.
The mandibular dentition should be decompensated before surgery to allow assessment of the
amount of transverse expansion necessary and to assist in preventing postexpansion relapse
with dental interdigitation.
2. In addition, the maxillary expansion appliance must be placed preoperatively and the appliance
key must be present in the operating suite to allow intraoperative activation.
Patient positioning in the operating room should be similar to that described for the Le Fort I
osteotomy. Nasal intubation is preferred. However, because maxillomandibular fixation is not
necessary for this surgical procedure, oral intubation can be used.
Following SARPE, the maxilla should be allowed to remain stationary for five days prior to
initiation of expansion of the maxilla at 0.5mm/day (this allows capillary healing across the
osteotomy area- Ilizarov theory of distraction).
In theatre, the appliance should be widened 3 to 4 mm and then turned back to a final opening
of 1 to 1.5 mm to loosen the sutures. During maximal expansion, the surgeon should check that
both maxillae are adequately mobile. If they are not, the osteotomies should be checked or
more surgery performed.
SARME can also be used in cases of unilateral or asymmetric maxillary deformities. In this
situation, the osteotomies outlined earlier are created on only 1 side, thus allowing a differential
anchorage situation with more expansion on one side. As would be expected, on the
nonoperated side, buccal bone bending and dental tipping occur. After appliance removal,
almost complete relapse occurs on the nonoperated side.
It is better to divert the root of the central to allow surgical cut
Palatal tori can be a significant barrier to palatal expansion and the presence of a palatal torus
in this situation can be approached in 2 different ways.
1. The ideal treatment is to surgically remove the torus 4 to 6 months before the
SARME procedure.
2. Removal of the torus can be performed if the surgeon is willing to place the
expansion appliance intraoperatively. The appliance must be fabricated on a model
from which the torus has been removed. Because a midpalatal incision is necessary
to remove the torus, but this could compromise palatal blood supply, thus the
osteotomies should be performed through vertical incisions in the buccal mucosa
combined with subperiosteal tunneling.
3. When performing SARME on patients with a skeletal open bite or open-bite tendency, care
must be taken to prevent worsening of the open bite with this procedure. Prevention of this
problem requires modification of the SAME technique to ensure that all osteotomies of the
anterior and lateral maxillary walls are parallel to the maxillary occlusal plane.
If a secondary Le Fort I maxillary osteotomy is planned because of the existence of other
dentofacial deformities, the osteotomies for SARME should be placed in the location of the
planned osteotomy cut of the future Le Fort procedure. This strategy is because the osteotomies
in the anterior and lateral maxillary walls seldom completely heal after SARME, and this may
compromise future osteotomies or the ability to apply rigid fixation.
Postoperative care, rehabilitation, and recovery
After two to three days expansion, an anterior occlusal radiograph should be taken to assess
symmetrical separation of the palatal segments
Particular note should be taken to see that the lamina dura remains intact on both central
incisors.
Routine follow-up care should be similar to that of the Le Fort I osteotomy, with the exception
that liquid diet is followed for only the first week and the diet is advanced from that time
forward.
After the surgical procedure, the maxilla should remain stationary for at least 5 days before
initiation of expansion at a rate of 0.5 mm/d (2 activations of the jack screw appliance a day).
The period of retention after expansion varies from 2 to 12 months. Generally, a period of 3
months is used.
Indications for SARME
Failed orthodontic expansion
Adult patient with skeletal maturity, once skeletal maturity has been reached, orthodontic
treatment alone cannot provide a stable widening of the constricted maxilla in cases of
deficiencies of more than 5 mm. The amount of distraction at the canine level mentioned varies
from 3.4 to 5.0 mm, in the first premolar region 4.7 to 5.9 mm and in the first molar region 3.4
to 8.0 mm.
4. Sever maxillary transverse deficiency >5mm
Extremely thin, delicate gingival tissue or presence of significant buccal gingival recession in
the canine-premolar region in the maxilla
Advantages of SARME (Koudstaal et al. 2005)
Better periodontal health than conventional expanders
improved nasal air flow;
elimination of the negative space i.e. cosmetic improvement of the buccal hollowing secondary
to post-expansion prominence at the site of the lateral wall osteotomy
Tooth extractions for alignment of dental arches are often unnecessary
Evidence
Surgical and non-surgical techniques: No significant difference in stability of expansion after
1 yr Berger et al., 1998. In summary, they reported on two groups of patients using both RME
and SARME with a hyrax expander. In the RME group the ages ranged from 6 to 12 years. In
the SARME group the ages ranged from 13 to 35 years. They concluded that there is no
difference in the stability of SARME and RME.
Problems
PD damage at area of osteotomy
Root damage at area of osteotomy
Oronasal fistula
Numbness of lip and palate due to osteotomy side effect
Risk of nasal septum deviation
asymmetrical expansion, nasal septum deviation
Rarely, life threatening epistaxis to a cerebrovascular accident, skullbase fracture with
reversible oculomotor nerve pareses and orbital compart- ment syndrome
Difference between SARME and segmental maxillary osteotomy
SARME more stable than same day expansion 1-15% and 30-40% respectively. (Pogrel
and associates studied 12 patients 1 year after SAME (still in orthodontic appliances)
and found an 11.8% relapse at the maxillary first molar. Bays and Greco studied 19
patients who had undergone SAME who had completed orthodontic therapy more than
5. 6 months previously and found an 8.8% relapse at the canines, 1% at the first bicuspid,
and 7.7% at the first maxillary molar. The reported relapse in the transverse component
of segmental maxillary osteotomies has been considerably higher. Stephens found a
30% and 23% relapse at the canine and molar regions, respectively, in 15 patients who
had undergone segmental maxillary osteotomies with an average follow-up of
47.5 months after debanding. Phillips and colleagues compared the transverse stability
in 39 patients who underwent either a 2-piece Le Fort osteotomy (n = 26) or a 3-piece
Le Fort osteotomy (n = 13). The postorthodontic follow-up was 14 to 47 months
(mean = 24.4 months). Significant transverse relapse in both groups was observed,
ranging from 11% at the canines to 47% at the second molar in the 2-piece group and
from 30% at the first premolar to 51% at the first molar in the 3-piece group.)
The pattern of transverse expansion is different for SAME than for maxillary segmental
osteotomies. More expansion occurs at the canines and less at the molars after SAME.
In contrast, during segmental Le Fort maxillary osteotomy, more expansion is achieved
at the maxillary molars than at the canines. In the SAME procedure, all the maxillary
articulations are not osteotomized superiorly and posteriorly (lateral nasal wall and
palatine bone); therefore, the greater resistance to expansion in the posterior maxilla
accounts for less posterior expansion. The inelasticity of the palatal mucosa is a major
limiting factor for segmental Le Fort osteotomy. Widening of more than 6 mm is not
stable or feasible. Therefore, transverse expansion greater than 7 mm would be an
indication for SAME.
Extraction and expansion: SAME is generally performed early in the treatment
sequence. Early expansion of the maxilla allows orthodontic alignment in the severely
crowded maxillary arch without the need to extract teeth. Treatment plans that include
a segmental maxillary osteotomy often include extraction of teeth with partial
orthodontic space closure to allow for safe performance of interdental osteotomies. In
nonextraction segmental osteotomies, the dentition requires buccal expansion before
surgery, which is unstable and prone to postoperative relapse.
The segmental maxillary osteotomy is a more difficult, more technically sensitive, and
potentially more morbid procedure
The major disadvantage of a treatment plan that includes SAME followed by a 1-piece
Le Fort maxillary osteotomy is that 2 surgical procedures are required. If a patient who
has had a SAME procedure requires a Le Fort osteotomy for correction of concomitant
6. dentofacial deformity, a second procedure must occur after orthodontic
decompensation of the maxillary and mandibular dentition. In contrast, a segmental
maxillary osteotomy attempts to correct the deformities in all planes of space during 1
surgical procedure.