Adult transverse diagnosis and treatment: A case-based review

Interdisciplinary treatment of mutilated dentition and transverse maxillary deficiency with microimplant-assisted rapid palatal expansion, microimplants, and dental implants

OBJECTIVE

This case report demonstrates an interdisciplinary approach to treat a 26-year-old male patient with hyperdivergent Class II skeletal pattern, maxillary transverse deficiency, slight anterior open bite, and multiple hopeless teeth with root rests.

CLINICAL CONSIDERATIONS

An interdisciplinary treatment was required for oral hygiene improvement, caries treatment, extraction of residual roots and hopeless teeth, maxillary expansion using microimplant-assisted rapid palatal expansion, improvement of skeletal and dental relationship using orthodontic microimplants, and prosthetic restorations with the aid of dental implants.

CONCLUSION

Consequently, esthetic and functional occlusal rehabilitation was achieved.

CLINICAL SIGNIFICANCE

Hyperdivergent Class II facial and skeletal patterns with multiple missing teeth can be effectively treated using orthodontic skeletal anchorage. In young adults, the transverse discrepancy can be resolved using MARPE, which is also useful for improving the sagittal and vertical relationships. In the case of multiple missing teeth, orthodontic treatment can provide the proper space to facilitate dental implants to achieve optimal esthetics and function.

Changes in the nasal and pharyngeal airway volume with miniscrew-assisted rapid palatal expansion appliances

Objectives:

The purpose of this study was to assess the volumetric changes in the nasal and pharyngeal airway volume in patients with maxillary transverse deficiency treated with miniscrew-assisted rapid palatal expansion (MARPE) appliances.

Material and Methods:

The pre- and post-treatment cone-beam computed tomography scans of 20 subjects who underwent treatment with the MARPE appliance as part of their orthodontic treatment were included in the study. Pre- and post-expansion airway volume measurements of the nasal cavity, nasopharynx, and oropharynx were measured. Linear measurements of the skeletal structures surrounding the nasal cavity were taken to assess the pattern of airway expansion. Paired t-tests were used to evaluate nasal and pharyngeal airway volume changes with expansion. Pearson correlation test was utilized to assess the relationship between nasal and pharyngeal volume changes.

Results:

A total of 17 out of 20 samples had a successful split of the mid-palatal sutures. A significant increase in nasal airway volume (12.0%) was found post-expansion. In addition, a significant increase in linear measurements of the nasal cavity base width in the frontal plane (7.1%) and both the anterior and posterior widths in the transverse dimension (9.4% and 3.4%, respectively) were found. Significant positive correlations were found between airway volumes and increase in width of the maxillary expansion appliance.

Conclusion:

The effects of maxillary expansion with a MARPE appliance include an increase in nasal cavity volume, but not the nasopharyngeal and the oropharyngeal airway volume. The nasal cavity expands in a triangular pattern in both the frontal and transverse dimensions following orthopedic expansion with the MARPE appliance. Increase in airway volume is a result of the increase in width of the maxillary expansion appliance.

Can palatal depth influence the buccolingual inclination of molars? A cone beam computed tomography-based retrospective evaluation

Objective:

To interpret a correlation between buccolingual inclination of molars and palatal depth in hyperdivergent patients and to identify importance of determining inclination of molars in assessing transverse discrepancies (as skeletal or dental)

Design:

This was a retrospective cone beam computed tomography (CBCT) study.

Setting:

The study was conducted in the Department of Orthodontics, Saveetha Dental College and Hospital, Tamil Nadu, India.

Methods:

This was a retrospective CBCT study of 79 patients who underwent diagnostic CBCT for treatment purposes. The CBCT scans were evaluated systematically and the required parameters were accessed with suitable reference planes. Student’s t-test (95% confidence interval) was performed to determine buccolingual inclination of first molars between the right and left sides. Only patients with a vertical growth pattern and skeletal class I relation were included and they were classified into three groups based on their palate depth.

Results:

In patients with palatal depth > 22 mm, the mean inclination of molars was 7.4°; with palatal depth in the range of 19–22 mm, the mean inclination of molars was 5.23°; and with palatal depth < 19 mm, the mean inclination of molars was 2.9°. Results showed that there was a significant correlation between the buccolingual inclination of molars and the palate depth in vertical growers ( P < 0.05).

Conclusion:

The buccolingual inclination of first molars is increased in patients with greater palatal depth. This parameter is helpful in classifying crossbites as skeletal or dental. The amount of compensation required to correct the cross bite can be adjusted using Korkhaus Index.

Expansion in the absence of crossbite – rationale and protocol

Transverse maxillomandibular discrepancies are a major component of several malocclusions. Clinically, posterior crossbite is a common and valid indicator of maxillary transverse problems and orthopedic and orthodontic forces are routinely used to correct maxillary transverse deficiency. However, crossbite and transverse discrepancies are not a homologous group but must be viewed as a continuum with varying degree of abnormality. The etiology, diagnostic protocol, rationale, and procedures employed for correcting maxillary transverse discrepancy in the absence of crossbite are discussed in the article.