Treatment of maxillary transversal deficiency by using a mini-implant-borne rapid maxillary expander and aligners in combination

•If a mini-implant borne expander is used, dental side effects in terms of tipping teeth can be avoided.•A pre-fabricated allows single appointment for insertion mini-implants and the expander.•The use also reasonable since left place as skeletal retainer during aligner finishing. Bone-borne rapid maxillary expansion distraction devices are used to achieve more avoid conventional expanders such anchorage teeth. In this article, we report prefabricated fixed on 2 anterior palate. This occur without need an impression or any laboratory procedures. Especially when aligners going mini-implant-borne seems because Maxillary transverse deficiency common orthodontic problem, it often associated with unilateral bilateral posterior crossbite. Rapid (RME) considered optimal procedure widening maxilla.1Kurol J. Berglund L. Longitudinal study cost-benefit analysis effect early treatment cross-bites primary dentition.Eur J Orthod. 1992; 14: 173-179Crossref PubMed Scopus (154) Google Scholar,2Camacho M. Chang E.T. Song S.A. Abdullatif Zaghi S. Pirelli P. et al.Rapid pediatric obstructive sleep apnea: systematic review meta-analysis.Laryngoscope. 2017; 127: 1712-1719Crossref (67) Scholar Because forces usually transmitted structures via anchor teeth, distribution many possible completion root growth essential. However, besides therapeutically intended expansion, resorption, decrease buccal bone thickness dehiscence, loss marginal height resulting gingival recessions may occur.3Garib D.G. Henriques J.F. Janson G. de Freitas M.R. Fernandes A.Y. Periodontal tooth-tissue-borne tooth-borne expanders: computed tomography evaluation.Am Orthod Dentofacial Orthop. 2006; 129: 749-758Abstract Full Text PDF (165) Scholar, 4Schuster Borel-Scherf I. Schopf P.M. Frequency complications RPE appliances—results survey Federal State Hesse, Germany.J Orofac 2005; 66: 148-161Crossref (28) 5Erverdi N. Okar Kücükkeles Arbak A comparison two different palatal techniques from point resorption.Am 1994; 106: 47-51Abstract (59) 6Akyalcin Alexander S.P. Silva R.M. English J.D. Evaluation three-dimensional surface changes resorption following expansion: cone beam investigation.Orthod Craniofac Res. 2015; 18: 117-126Crossref (17) To reduce unwanted several appliances have recently been introduced, which share load between 2-4 mini-implants. Wilmes al7Wilmes B. Nienkemper Drescher D. Application effectiveness mini-implant- device: hybrid hyrax.World 2010; 11: 323-330PubMed introduced hyrax 2007 using palate (deciduous) molars.8Wilmes miniscrew system interchangeable abutments.J Clin 2008; 42 (quiz 595): 574-580PubMed 9Wilmes Fields application mini-implants.in: Ludwig Baumgaertel Bowman Innovative concepts. Mini-implants orthodontics. Quintessenz, Berlin2008: 91-122Google 10Wilmes Anwendungsgebiete von Mini-Implantaten.in: Mini-Implantate der Kieferorthopädie—Innovative Verankerungskonzepte. Berlin2007: 89-120Google Similar were published years by Garib al11Garib Navarro R. Francischone C.E. Oltramari P.V. implants.J 42: 665-671PubMed 2008, Lee al12Lee K.J. Park Y.C. J.Y. Hwang W.S. Miniscrew-assisted nonsurgical before orthognathic surgery patient severe mandibular prognathism.Am 137: 830-839Abstract (113) 2010, Moon al13Moon W. Wu K.W. MacGinnis Sung Chu H. Youssef al.The efficacy protraction protocols micro-implant-assisted (MARPE) novel N2 mini-implant-a finite element study.Prog 16: 16Crossref (20) 2015, called assisted expansion. The T-Zone provides safe area away tooth roots blood vessels while providing best quality cortical bone.14Wilmes Vasudavan T-Zone: median vs. paramedian Insertion Mini-Implants.J 2016; 50: 543-551PubMed 15Becker K. Unland Tarraf N.E. Is there ideal angle position palate? CBCT humans.Am 2019; 156: 345-354Abstract (11) 16Kang S.J. Ahn Heo M.S. Kim T.W. Bone adults.Am 2007; 131: S74-81Abstract (128) Many studies shown advantages compared inducing less expansion,17Celenk-Koca T. Erdinc A.E. Hazar Harris Akyalcin miniscrew-supported adolescents: prospective randomized clinical trial.Angle 2018; 88: 702-709Crossref (33) Scholar,18Lin H.W. S.C. S.H. Nelson Tooth-borne vs bone-borne late adolescence.Angle 85: 253-262Crossref (84) thicknesses teeth,19Gunyuz Toklu Germec-Cakan Tozlu Periodontal, dentoalveolar, tooth-bone-borne appliances.Am 148: 97-109Abstract (39) significantly higher nasal airway flow20Bazargani F. Magnuson A. Effects airflow resistance RME appliances: controlled trial.Eur 40: 281-284Crossref (23) teeth.21Yildirim Akin Comparison after evaluated microtomography.Am 155: 182-190Abstract (6) disadvantage local analgesia no difference pain intensity discomfort appliance anchored appliance.22Feldmann Bazargani Pain first week 87: 391-396Crossref insert mini-implants, take impression, scan, manufacture then subsequent appointment. 2-step procedure, was designed, inserted same immediately placement. 3 sizes (on basis distance centers: 6, 8, 10 mm) adapted directly chairside. After sites (T-Zone), appropriate size chosen additionally pre-turning screw. activated over mm, means even if maximum mm done, 8 still available An increasing number patients present seeking invisible esthetic clear sequential thermoplastic aligners. objective bodily movement therapy exclusively prove challenging high degree predictability.23Papageorgiou S.N. Koletsi Iliadi Peltomaki Eliades Treatment outcome meta-analyses.Eur 2020; 331-343Crossref Scholar,24Papadimitriou Mousoulea Gkantidis Kloukos Clinical Invisalign® treatment: review.Prog 19: 37Crossref (54) especially true attempting significant amount arch. Houle al25Houle J.P. Piedade Todescan Jr., Pinheiro F.H. predictability Invisalign.Angle 19-24Crossref (31) Zhou Guo26Zhou Guo Efficiency upper arch Invisalign system.Angle 90: 23-30Crossref (12) reported instead desired only Consequently, beneficial combine treat transversal wish treatment. 13-year-old female presented (Fig 1). Intraoral examination showed crossbite permanent dentition. panoramic radiograph revealed presence all third molars. Pretreatment lateral cephalometric mild Class III (Wits, −1.2 mm; ANB, 0.5°) slightly prognathic mandible (SNB, 83.2°; Table). relative merits, shortcomings, risks each modality clearly explained her parents. They made informed decision proceed maxilla leveling afterward.TableCephalometric summariesMeasurementsPretreatmentPosttreatmentNSBa122.3°126.6°NL-NSL6.8°7.8°ML-NSL26.9°27.3°ML-NL20.1°19.5°SNA83.7°84.3°SNB83.2°83.2°ANB0.5°0.7°Wits−1.2 mm−1.9 mmU1-NL115.0°114.6°L1-ML88.5°89.7°U1-L1136.4°136.2°Overjet2.1 mm2.8 mmOverbite2.0 mm1.8 Open table new tab started (2 × 9 under anesthesia 2, A). B; BMX expander, psm North America, Inc, La Quinta, Calif) screw chairside fixation screws C). Expansion activation initiated performing 1 per day total about 0.2 day. 4 weeks activation, expanded approximately 5.5 (Figs 4). Subsequently, scans taken finishing (Clear Correct, Round Rock, Tex; Fig 5). stayed retention substituted miniplate comfort 6). 7) comprised 22 (2-week change), including refinement finished months 8). whole duration 12 (1 month manufacturing, finishing). For retention, removable vacuum-formed retainers prescribed. occlusion improved settling period 6 9).Fig 3Intraoral situation expansion.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Fig 4Superimposition matching rugae.39Becker Grandjean C. Impact manual control selection accuracy automated digital models.Clin Oral Investig. 22: 801-810Crossref A, Measurement distances (in Blender software, version 2.8). B, Cross-section mesiobuccal cusps molars.View 5Treatment planning (before after).View 6Skeletal miniplate.View 7Aligners situ.View 8Treatment result time months.View 9Occlusal phase (after months).View (PPT) occurs expansion.25Houle Scholar,26Zhou some clinicians prefer 2-phase strategy: (1) plus period, (2) strategy long needed period. second flaw overcorrection risk relapse phase. If first, second, purposes interferences moved. addition, borne.21Yildirim additional RME.22Feldmann failure rate 1%-5%, lower than other regions.27Di Leonardo Lisson J.A. Contardo Mura Hourfar torque values success rates mini-implants: retrospective study.J 79: 109-115Crossref 28Hourfar Bister Kanavakis Influence interradicular placement (survival) rate.Head Face Med. 13: 14Crossref 29Lim H.J. Choi Y.J. Evans C.A. H.S. Predictors initial stability implants.Eur 2011; 33: 528-532Crossref (34) 30Mohammed Wafaie Rizk M.Z. Almuzian Sosly Bearn D.R. Role anatomical correlated factors survival implants: meta-analysis.Prog 36Crossref (29) 31Karagkiolidou Pazera Pandis Katsaros Survival miniscrews anchorage: cohort study.Am 2013; 143: 767-772Abstract (49) palate, superior quantity combined thin attached mucosa minimal tooth-root injuries observed.28Hourfar Scholar,29Lim Scholar,32Ludwig Glasl Kinzinger G.S. Anatomical guidelines insertion: sites.J 45 467): 433-441PubMed zone lowest rugae.14Wilmes Scholar,15Becker benefit temporary (TADs) has questioned previously literature.33Lagravère M.O. Carey Toogood R.W. Major P.W. Transverse, vertical, anteroposterior bone-anchored traditional trial.Am 137 (discussion 304-5): 304.e301-304.e312Google literature reviews molar tipping.17Celenk-Koca Scholar,20Bazargani Scholar,34Moon M.J. Chung K.R. al.Molar inclination surrounding alveolar change design study.Angle 13-22Crossref (19) Scholar,35Kayalar E. Schauseil Kuvat S.V. Emekli U. Fıratlı surgically cone-beam Craniomaxillofac Surg. 44: 285-293Crossref From our experience, site might play important role how TADs When process, they seem advantage eliminating segments basal expansion.36Ludwig Zorkun Bonitz al.Application viscoelastic method model treatment.Am 426-435Abstract (46) patient, daily very slow (0.2 mm/d). movements avoided.37Baccetti Franchi Cameron C.G. McNamara timing expansion.Angle 2001; 71: 343-350Crossref movement. Future evaluate rate. Studies assess up age sufficient (present aged 13 years). Carlson al38Carlson McComb Machado A.W. Microimplant-assisted orthopedically correct adult.Am 149: 716-728Abstract (76) that achieved adult surgical assistance. With case, appears nearly 1:1 molars turning (rough 5.6 weeks, around 5.2 mm). only, little potential thus overcorrection. First, not loaded likely relapse. Second, retain width relatively should investigated larger sample future. impression. now approach replicated group older anticipated suture.