Since 1977 cleft lip and palate (CLP) patients with maxillary deficiency have received an interceptive orthopedic treatment consisting of (a) transverse expansion, (b) protraction, and (c) fixed retention. Ideally the treatment should be completed early enough to permit spontaneous eruption of the maxillary permanent incisors into normal occlusion without orthodontic intervention. The early transverse expansion considerably increases space so that unerupted malpositioned incisors spread out spontaneously, creating optimal conditions for eruption and root formation. Dental diagnosis in the cleft areas is made easier. Posterior crossbites in 112 CLP patients were expanded with a modified quad-helix appliance cemented with four bands in the deciduous or mixed dentition. Intercanine widening was about 3 mm per month regardless of cleft type. Several authors have claimed that transverse expansion of the upper jaw will increase sagittal overjet. Other authors have not found such an effect. The sagittal effect on the maxilla was studied in 68 CLP patients who had received transverse expansion. Analysis of the lateral cephalograms revealed no significant sagittal dentofacial maxillary treatment effects involving forward movement of maxilla, but a downward clockwise rotation of the mandible was found.

Intercanine Widening and Sagittal Effect of Maxillary Transverse Expansion in Patients with Cleft Lip and Palate during the Deciduous and Mixed Dentitions

Objective:This prospective study evaluated the density of the midpalatal and transverse sutures as assessed by low-dose CT before rapid maxillary expansion (T0), at the end of active expansion (T1) and after a retention period of 6 months (T2).Methods:The study sample comprised 17 pre-pubertal subjects (mean age 11.2 years) with constricted maxillary arches. Total amount of expansion was 7 mm in all subjects. Multislice low-dose CT scans were taken at T0, T1 and T2. On the axial CT scanned images six regions of interest (ROIs) were placed along the midpalatal and transverse sutures and two in maxillary and palatal bony areas. Density was measured in Hounsfield units. Mann–Whitney U test and Friedman analysis of variance with post hoc tests were used (p < 0.05).Results:The three ROIs in the midpalatal suture showed a significant decrease in density from T0 to T1, a significant increase from T1 to T2 and a lack of statistically significant differences from T0 to T2. Both ROIs located in the transverse sutur...

/pdf/three-dimensional-densitometric-analysis-of-maxillary-2rml4qwcdf.pdf

Three-dimensional densitometric analysis of maxillary sutural changes induced by rapid maxillary expansion.

......................................................................................... 236

/pdf/estudo-comparativo-por-meio-de-analise-cefalometrica-em-2a786dvxx4.pdf

Estudo comparativo, por meio de análise cefalométrica em norma frontal, dos efeitos dentoesqueléticos produzidos por três tipos de expansores palatinos

/pdf/estudo-cefalometrico-em-norma-lateral-das-alteracoes-2x5nksaz8e.pdf

Estudo cefalométrico em norma lateral das alteraçöes dentoesqueléticas produzidas por três expansores: colado, tipo Haas e Hyrax

OBJECTIVES: To evaluate the new bone formation at the midpalatal suture in adult patients submitted to surgically assisted rapid maxillary expansion. METHODS: Regular conventional occlusal radiographs were obtained from the initial stage up to 120 days and digitized with a scanner with transparency adapter for evaluation of optical density. RESULTS: The optical density presented an increase at the final stage of retention, yet the pixel values achieved at 120 days were significantly lower than the values of the initial stage. CONCLUSIONS: 1) the pixel values exhibited an individual variability in the process of suture remodeling; 2) there was no similarity of optical density between the final period of retention and the initial values, demonstrating that the 120-day period was not enough for complete new bone formation and bone remodeling at the suture; 3) the results achieved by the computerized method corresponded to the information achieved on the conventional occlusal radiographs, adding the quantitative analysis of the obtained data, and may be used as a complementary diagnostic method in the orthodontic clinic.

/pdf/avaliacao-da-neoformacao-ossea-na-sutura-palatina-mediana-326l41pai8.pdf

Avaliação da neoformação óssea na sutura palatina mediana por meio de radiografia digitalizada após a expansão assistida cirurgicamente

No Available. This was supported financially in part, National Institutes of Health Grant #5SO1FR05302-06.

Adaptive changes in the face of the Macaca mulatta monkey following orthopedic opening of the midpalatal suture.

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Adaptive changes in the face of the Macaca mulatta monkey following orthopedic opening of the midpalatal suture.