indications and contraindications of rapid maxillary arch expansion,appliances used and effects of rapid maxillary arch expansion/ comparison between rapid and slow expansion

1. Introduction to
Maxillary Arch Expansion
Resource Faculty:
Dr. Prabhat Ranjan Pokharel
Dr. Rajesh Gyawali
Dr. Jamal Giri
Dr. Mona Pokharel
Department of orthodontics
BPKIHS, Dharan
Presenter:
Prawin Chandra
Kushwaha

2. CONTENS
1. Definition and Classification
2. Indications for Maxillary Expansion
3. Rapid Maxillary Expansion
4. Applied Anatomy
5. Indications and Contraindications for R.M.E
6. Effects of R.M.E
7. Appliances used

3. 1. EXPANSION is a method of gaining space.
2. Correction of transverse maxillary deficiency.
3. First achieved by Emerson C. Angell in 1860.
4. Numerous factors influence this including,
age, growth potential, amount of force and
even sex of the patient.

4. Classification
Based on the type of expansion
1. Orthodontic
2. Orthopedic
3. Passive
Based on the rate of expansion
1. Rapid
2. Slow

5.  Orthodontic or dental expansion - it results
in lateral movement of buccal segments that
primarily are dentoalveolar. eg.fingerspring
appliance
 Orthopedic or skeletal expansion - here the
changes are produced primarily in the skeletal
structures rather than by the movement of
teeth through alveolar bone. eg.RME

6.  Passive expansion- when the forces of
buccal and lingual musculature are shielded
from occlusion ,a widening of dental arches
often occur which occurs due to the intrinsic
forces such as tongue.eg:FR-2, lip bumper
therapy
Conted

7. Indications for Maxillary
Expansion
1. Crossbites
2. Mild Crowding
3. Expansion along with Functional appliance
treatment
4. Skeletal class III malocclusion
5. Distal molar movement
6. Surgical Orthodontics

9. Applied anatomy
 Maxilla together with the palatine bone forms
the hard palate, floor and greater part of the
lateral walls of the nasal cavity.
 Most of the sutural attachments of the maxilla
to the adjoining bones (frontal, ethmoid, nasal
, lacrimal, vomer, zygomatic and palatine) are
at its posterior and superior aspects leaving
the anterior and inferior aspects free, which
make it vulnerable for lateral displacement.

12. Rapid Maxillary Expansion
Also called Rapid palatal expansion or Split palate.
 Definition:
It is a skeletal type of expansion
that involves the separation of the
mid-palatal suture and movement of the
maxillary shelves away from each other.
 Emerson C. Angell is considered as
the father of rapid maxillary expansion

13.  RME should be initiated prior to the
ossification of the mid – palatal sutre.
 Melsen – Transverse growth of the mid-palatal
suture continued upto 16 years in girls and 18
years in boys.
 The sphenoid and the zygomatic bones have
a buttressing effect resisting mid palatal
suture opening.

14.  1ST STAGE (infancy)
 2ND STAGE (Childhood)
 3RD STAGE (Early Adolescence)

15. INDICATIONS OF R.M.E
 Posterior crossbite associated with real or
relative maxillary deficiencies.
 Class III malocclusion of dental or skeletal
cause.
 Cleft palate patiens with collapsed maxillary
arch.
 In patients requiring facemask therapy.
 Medical indications:

16. Effects of RME
 Maxillary skeletal effect.
 Effect on maxillary anterior teeth.
 Effect on maxillary posterior teeth.
 Effect on mandible.
 Effect on adjacent cranial bones and sutures.
 Effect of RME on nasal cavity.

18. Types of appliance used:
1.Removable Appliance:
Consists of a split acrylic plate with a midline
screw

19. 2.Fixed appliance:
 Tooth borne:
1. -HYRAX TYPE
2. -ISAACSON TYPE
 Tooth and tissue borne:
1. -DERICHSWEILLER TYPE
2. -HASS TYPE

20. 3.Banded and Bonded
4.Slow and Rapid

21. Treatment evaluation
 Midline diastema.
 Maxillary occlusal radiograph.
 P.A. cephalogram.

22. CONTRAINDICATIONS
1. Single tooth crossbite.
2. In un-cooperative patient.
3. After ossification of mid palatal suture unless
accompanied by surgical procedures.
4. Skeletal asymmetry of maxilla and mandible
and severe anteroposterior skeletal
discrepancies.
5. Vertical growers with steep mandibular plane
angle.
6. In periodontically weak dentition.
7. Anterior open bite

23. Retention following R.M.E
 3 to 6 months.
 Isaacson – use of R.M.E appliance itself.
the screw should be immobilized using cold
cure acrylic.
Alternatively, either a removable or fixed retainer
(e.g TPA) can be used.

24. SURGERY AS AN ADJUNCT
Surgically Assisted Rapid Palatal
Expansion (SARPE)
 Patients who exhibit unusual resistance to
separation of the palatine bone or whom the
mid-palatal suture has ossified require surgical
intervention.
 It may also be required in patients exhibiting
increased circum-maxillary rigity as a result of
aging.

25. The surgical procedures carried out are:
1. Palatal osteotomy
2. Lateral maxillary osteotomy
3. Anterior maxillary osteotomy
It is the least stable orthognathic surgical
procedure ,as it causes widening of the maxilla,
stretches the palatal mucosa and its elastic rebound
is the major cause for relapse.

26. SLOW EXPANSION
 This technique is a more physiological
adjustment to maxillary expansion.
 It has greater stability and less relapse potential
than rapid expansion procedures.
 The maxillary arch is expanded at a rate of 0.5 to
1mm per week.

27.  The force generated is about 2 to 4 pounds.
 It takes as much as 2 to 5 months followed by
retention
 Here no midline diastema occurs.

29. COMPARISON BETWEEN SLOW AND
RAPID EXPANSION
FEATURES SLOW
EXPANSION
RAPID
EXPANSION
Type of expansion Mostly dental Skeletal
Rate of expansion Slow rapid
Type of tissue reaction Mostly physiologic More traumatic
Forces used Milder force Greater forces
Frequency of activation Less frequent More frequent
Duration of treatment Long Short
Type of appliance Either fixed or
removable
Mostly fixed
Age Any age Before fusion of
mid-palatal suture
Retention Less chance of
relapse
More chance of
relapse

30. SUMMARY

31. References:

32. • Case Report
• Expansion/Facemask Treatment o
f an Adult
• Class III Malocclusion
• Gregory W. Jackson• 1
• 2
• 1
• and Neal D. Kravitz
• 2
• Department of Orthodontics (M/C 841), College of Dentistry, University of Illinoi
s at C801S.PaulinaStreet,Chicago,IL60612,USA