Surgical treatment of maxillary transverse deficiency: retrospective study of 14 patients

A comparison of different osteotomy techniques with and without pterygomaxillary disjunction in surgically assisted maxillary expansion utilizing modified hybrid rapid maxillary expansion device with posterior implants: A finite element study

INTRODUCTION

The study aims to evaluate the effect of osteotomies with and without Pterygomaxillary disjunction (PMD) during Surgical Assisted Rapid Maxillary Expansion on the displacement pattern and stress distribution of Dental and Skeletal structures of the Nasomaxillary (NM) complex by a modified rapid maxillary expansion (RME) Hybrid appliance.

MATERIALS AND METHODS

A CT scan of a 20-year-old adult with maxillary constriction and the posterior bite was utilized for the restructuring of the finite element model. Five different meshed models were created individually with varying procedures of the osteotomy. A posteriorly anchored Hybrid-Hyrax appliance was utilized for RME. Groups included Group 0 - Control group without osteotomy; Group I - Only Midpalatal osteotomy; Group II - Only Subtotal Le fort I; Group III - Both Midpalatal and Subtotal Le fort I without PMD; Group IV - Midpalatal + subtotal Le fort I with bilateral PMD. The displacement pattern and stress distribution in all three dimensions were recorded and analyzed using analysis of variance and post-hoc Tukey test.

RESULTS

Group IV with PMD exhibited the highest stress dissipation and displacement of the skeletal and dental structures followed by Group III osteotomies. The highest stress concentration was at midpalatal suture (292 MPa) for Group III osteotomies. There is no statistical difference between Group III and Group IV osteotomies for many of the parameters measured (P > 0.05).

CONCLUSIONS

Posteriorly anchored Hybrid appliance without PMD is as effective as that with of PMD.

Surgically assisted rapid maxillary expansion: a systematic review of complications

A systematic review of the literature on the complications of surgically assisted maxillary expansion (SARME) was performed. The search strategy was based on the PRISMA guidelines. The PubMed, SCOPUS, and Cochrane Library databases were searched. Data were extracted from the full texts after screening of the abstracts and titles. Human clinical studies encompassing 'maxillary expansion', 'palatal expansion', 'SARME', or 'SARPE' and that reported sufficient data for 'complication' were included. In vitro studies, case reports, meta-analyses, reviews, book chapters, animal studies, and studies with missing or insufficient data were excluded. The final selection included 12 articles for data extraction. A total of 851 patients underwent SARME, with 187 reported complications (21.97%). Epistaxis (2.47%) and postoperative pain (2.00%) were the most often reported minor complications, and asymmetric or inadequate expansion presented an occurrence rate of 4.47%. Minor complications were equally distributed between surgical (49.30%) and orthodontic complications (50.70%). The technique without pterygomaxillary disjunction increased the occurrence of minor complications (29.95% vs. 16.87%), and the expansion pattern with less than 0.5 mm/day increased the occurrence of orthodontic complications (30.93% vs. 1.83%), i.e. asymmetric expansion. In conclusion, SARME procedures mostly present minor complications. Although several types of complication are described in the literature, occurrence rates are low, and technical issues such as pterygomaxillary disjunction and the pattern of distraction can be predictors of the complication risk.

Virtual Surgical Planning Assisted Management for Three-Dimensional Dentomaxillofacial Deformities

OBJECTIVE

Treatment of 3-dimensional dentomaxillofacial deformities remains a significant clinical challenge. This retrospective study aims to present the modalities of management for complex 3-dimensional dentomaxillofacial deformities with the assistance of virtual surgical planning (VSP) and 3-dimensional printed navigation templates.

STUDY DESIGN

Ten patients diagnosed with complex 3-dimensional dentomaxillofacial deformities received treatment of combined orthodontics and orthognathic surgery. Various surgical techniques as well as bone graft and distraction osteogenesis were used under the guidance of VSP and 3-dimensional printed navigation templates according to the characteristics of each patient. Follow-up included clinical examination and studies of spiral computed tomography preoperatively and for an average of 12 months postoperatively.

RESULT

The clinical outcomes of patients showed that VSP was successfully transferred to actual surgery in all the 10 patients. Three-dimensional dentomaxillofacial deformities were corrected significantly. Satisfactory profiles and occlusion were achieved.

CONCLUSION

The management of 3-dimensional dentomaxillofacial deformities required comprehensive consideration and detailed surgical planning. Virtual surgical planning serves as a reliable assistance in the management of 3-dimensional dentomaxillofacial deformities.