List of palatal expanders

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Upper and lower jaw functional expanders Upper and Lower Jaw Functional Expanders.jpg
Upper and lower jaw functional expanders

This article lists different types of expanders that are available for the process of palatal expansion in the field of orthodontics. [1] [2] There can be many types of transverse dimension appliances. These appliances can be used to achieve expansion in the maxillary arch; there are devices for mandibular expansion or lower expansion too. In past many years, different types of appliances have been made. These types are: tissue-borne, tooth-borne, slow maxillary expansion, rapid maxillary expansion, and bone-anchored.

Contents

Types of expanders

Tissue-borne expander

Tissue supported expanders allow the forces to be applied directly to the tissues of palatal mucosa instead of teeth. The most common type of tissue-borne expander is known as the Haas Appliance. This appliance was popularized by Andrew Haas in 1961. This appliance involves bands placed on maxillary first premolar and first molars on each side. Haas appliance has palatal acrylic that is in contact with palatal mucosa. Inside the acrylic there is a jackscrew that is embedded for patients to make turns to expand the device. In addition to the acrylic, support wires also extend from the premolars and molars to the appliance to add additional rigidity to the appliance.

Proponents of tissue-borne expansion believe that more bodily movement and less dental tipping is produced when an acrylic palatal coverage is added to the appliance. They believe that forces are dissipated through the mucosa and teeth. One of the disadvantages of this type of appliance is it leading to irritation of palatal mucosa.

Tooth-borne expander

Tooth supported expanders allow the forces to be applied directly to the teeth of maxillary arch instead of the tissue. The most common tooth-borne expander is known as the Hyrax (hygienic rapid expander) or Biedermann appliance. This appliance was developed by Bidermann. Hyrax is also known as the "hygienic appliance" because it does not lead to irritation of tissues due to the absence of palatal acrylic. The appliance is made mostly of stainless steel and includes bands being placed on maxillary first premolars and first molars. The appliance includes a jackscrew in the middle for patients to turn for expansion purposes. This appliance also has rigid wires extending from appliance to premolars and molars. It is important to note that the tooth-borne expanders can be divided into the Bonded vs. Banded Type of expanders. Hyrax appliance falls under the banded type appliance.

One of the concerns of this appliance is that due to the forces being applied only to the teeth, there may more dental tipping than skeletal expansion.

Bone-borne expander

Bone supported expanders allow the forces to be applied directly to the maxilla. Bone-borne expanders fall into two categories, MARPE and palatal distractors. Common types of MARPE include MSE (maxillary skeletal expansion), and DOME (distraction osteogenesis maxillary expansion). MARPE appliances anchor to the palatal vault area of the maxilla using 4-6 mini-screws (or TADs) which allows for expansion in adults as well as prevents tipping as is common in tooth-borne expanders. Unlike Surgically Assisted Rapid Palatal Expansion (SARPE), due to the absence of LeFort 1 osteotomy significant expansion of not only the maxilla but also the pharynx and nasal cavity can be achieved, which can be very effective in treating obstructive sleep apnea. [3] [4]

Comparison of different types

Many studies have been performed and published regarding the comparison of these two different types of appliance. It is important to note that the discrepancy that exists between different studies that has to do with the type of appliances they used in each category. A tooth-borne appliance can be designed in many different ways and same with tissue-borne appliance. The expanding protocol, retention protocol, exact timepoint of when the expansion was measured are some of the factors that can influence the results between different studies. Therefore, when evaluating studies and making conclusions, it is important to keep these confounding factors in mind. Information here may be outdated within 5–10 years as new RCTs, systematic reviews & meta-analysis will be done and they may produce different results then what are stated below.

Tissue-borne vs. tooth-borne expansion

In 2005 Garib et al., [5] stated in their study that tooth-borne (Hyrax) and tooth tissue-borne (Haas-type) expanders tended to produce similar orthopedic effects. In both methods, RME led to buccal movement of the maxillary posterior teeth, by tipping and bodily translation. They also mentioned that the second premolars displayed more buccal tipping than the supporting teeth and this could be due to 2nd premolars not being banded to the appliance. Another study performed by Weissheimer et al., [6] which was a randomized control trial, stated that both the appliances were efficient in correcting a transverse maxillary deficiency. Both the appliances showed pure skeletal expansion which was greater than actual dental expansion. The Hyrax-type expander produced greater orthopedic effects than did the Haas-type expander, but this effect was less than 0.5 mm per side and might not be clinically significant.

Tooth-borne vs. bone-borne expansion

A study published by Lin et al. [7] in 2015 found that for patients in late adolescence, bone-borne expanders produced greater orthopedic effects and fewer dento-alveolar side effects compared to the hyrax expanders. However, a study published by Lagravere et al. [8] in 2010, stated that there was no difference between the bone-borne and tooth-borne expansion devices. Both types of expanders showed similar results and that the greatest changes were seen in the transverse dimension, changes in the vertical and anteroposterior dimensions were negligible. A 2019 review found that both forms of expansion produced similar results. [9]

Rapid vs. slow expansion

A study published by Martina et al. [10] stated that rapid maxillary expansion is not more effective than slow maxillary expansion in expanding the maxilla in patients with posterior crossbite. It is important to keep in mind that different studies use different rapid and slow expansion devices and thus comparability between studies is difficult. A systematic review done by Zhou et al. [11] stated that slow maxillary expansion was superior to rapid maxillary expansion in expanding molar region of maxillary arch, but no difference was found when comparing their effectiveness in maxillary anterior region.

List of expanders

Related Research Articles

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<span class="mw-page-title-main">Dental braces</span> Form of orthodontics

Dental braces are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often used to correct underbites, as well as malocclusions, overbites, open bites, gaps, deep bites, cross bites, crooked teeth, and various other flaws of the teeth and jaw. Braces can be either cosmetic or structural. Dental braces are often used in conjunction with other orthodontic appliances to help widen the palate or jaws and to otherwise assist in shaping the teeth and jaws.

<span class="mw-page-title-main">Malocclusion</span> Medical condition

In orthodontics, a malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. The English-language term dates from 1864; Edward Angle (1855-1930), the "father of modern orthodontics", popularised it. The word "malocclusion" derives from occlusion, and refers to the manner in which opposing teeth meet.

<span class="mw-page-title-main">Palatal expansion</span> Orthodontics device to widen the upper jaw

A palatal expander is a device in the field of orthodontics which is used to widen the upper jaw (maxilla) so that the bottom and upper teeth will fit together better. This is a common orthodontic procedure. The use of an expander is most common in children and adolescents 8–18 years of age. It can also be used in adults, although expansion is more uncomfortable and takes longer in adults. A patient who would rather not wait several months for the end result achieved by a palatal expander may be able to opt for a surgical separation of the maxilla. Use of a palatal expander is most often followed by braces to then straighten the teeth.

Orthodontic technology is a specialty of dental technology that is concerned with the design and fabrication of dental appliances for the treatment of malocclusions, which may be a result of tooth irregularity, disproportionate jaw relationships, or both.

Dental anatomy is a field of anatomy dedicated to the study of human tooth structures. The development, appearance, and classification of teeth fall within its purview. Tooth formation begins before birth, and the teeth's eventual morphology is dictated during this time. Dental anatomy is also a taxonomical science: it is concerned with the naming of teeth and the structures of which they are made, this information serving a practical purpose in dental treatment.

<span class="mw-page-title-main">Crossbite</span> Medical condition

Crossbite is a form of malocclusion where a tooth has a more buccal or lingual position than its corresponding antagonist tooth in the upper or lower dental arch. In other words, crossbite is a lateral misalignment of the dental arches.

<span class="mw-page-title-main">Lingual arch</span>

A lingual arch is an orthodontic device which connects two molars in the upper or lower dental arch. The lower lingual arch (LLA) has an archwire adapted to the lingual side of the lower teeth. In the upper arch the archwire is usually connecting the two molars passing through the palatal vault, and is commonly referred as "Transpalatal Arch" (TPA). The TPA was originally described by Robert Goshgarian in 1972. TPAs could possibly be used for maintaining transverse arch widths, anchorage in extraction case, prevent buccal tipping of molars during Burstonian segmented arch mechanics, transverse anchorage and space maintenance.

Serial extraction is the planned extraction of certain deciduous teeth and specific permanent teeth in an orderly sequence and predetermined pattern to guide the erupting permanent teeth into a more favorable position.

A lip bumper is a dental appliance used in orthodontics, for various purposes to correct a dentition by preventing the pressure from the soft tissue. Lip bumpers are usually used in orthodontic treatment where the patient has a crowded maxillary or mandibular teeth in an arch.

Surgically assisted rapid palatal expansion (SARPE), also known as surgically assisted rapid maxillary expansion(SARME), is a technique in the field of orthodontics which is used to expand the maxillary arch. This technique is a combination of both Oral and Maxillofacial Surgery and Orthodontics. This procedure is primarily done in adult patients whose maxillary sutures are fused and cannot be expanded via other techniques.

Activator Appliance is an Orthodontics appliance that was developed by Viggo Andresen in 1908. This was one of the first functional appliances that was developed to correct functional jaw in the early 1900s. Activator appliance became the universal appliance that was used widely throughout Europe in the earlier part of the 20th century.

Frankel appliance or Frankel Functional Regulator is an orthodontic functional appliance which was developed by Rolf Fränkel in 1950s for treatment to patients of all ages. This appliance primarily focused on the modulation of neuromuscular activity in order to produce changes in jaw and teeth. The appliance was opposite to the Bionator appliance and Activator appliance.

Molar distalization is a process in the field of Orthodontics which is used to move molar teeth, especially permanent first molars, distally (backwards) in an arch. This procedure is often used in treatment of patients who have Class 2 malocclusion. The cause is often the result of loss of E space in an arch due to early loss of primary molar teeth and mesial (forward) migration of the molar teeth. Sometimes molars are distalized to make space for other impacted teeth, such as premolars or canines, in the mouth.

Pendulum is an orthodontic appliance, developed by James J. Hilgers in 1992, that use forces to distalize the upper 1st molars to create space for eruption of impacted teeth or allowing correction of Class 2 malocclusion. This appliance is a fixed type of distalizing appliance that does not depend on the compliance of each patient to work. Hilgers published an article in Journal of Clinical Orthodontics in 1992 describing the appliance.

ACCO or Acrylic Cervical Occipital Anchorage is an appliance in field of orthodontics which is used for distalization of maxillary molars. This appliance is a removable type of appliance which was developed by Herbert I. Margolis. This appliance is intended to be worn 24 hours a day except during meals. It is one of the few removable appliances made for distalization of molars and thus require patient compliance for the treatment to be successful.

Open bite is a type of orthodontic malocclusion which has been estimated to occur in 0.6% of the people in the United States. This type of malocclusion has no vertical overlap or contact between the anterior incisors. The term "open bite" was coined by Carevelli in 1842 as a distinct classification of malocclusion. Different authors have described the open bite in a variety of ways. Some authors have suggested that open bite often arises when overbite is less than the usual amount. Additionally, others have contended that open bite is identified by end-on incisal relationships. Lastly, some researchers have stated that a lack of incisal contact must be present to diagnose an open bite.

<span class="mw-page-title-main">Alveolar cleft grafting</span>

Alveolar cleft grafting is a surgical procedure, used to repair the defect in the upper jaw that is associated with cleft lip and palate, where the bone defect is filled with bone or bone substitute, and any holes between the mouth and the nose are closed.

References

  1. ↑ Timms, Donald J. (1986-07-01). Rapid Maxillary Expansion. Chicago: Quintessence Publishing Co., Inc. ISBN   9780931386497.
  2. ↑ Padmakumar, Vinayak; Hegde, Amitha; Shetty, Rajmohan Y. (2015-01-01). Rapid Maxillary Expansion. Saarbrücken. ISBN   9783659612022.{{cite book}}: CS1 maint: location missing publisher (link)
  3. ↑ Yoon, A.; Guilleminault, C.; Zaghi, S.; Liu, S. Y. (2020). "Distraction Osteogenesis Maxillary Expansion (DOME) for adult obstructive sleep apnea patients with narrow maxilla and nasal floor". Sleep Medicine. 65: 172–176. doi:10.1016/j.sleep.2019.06.002. PMID   31606311. S2CID   196555256.
  4. ↑ Li, K.; Quo, S.; Guilleminault, C. (2019). "Endoscopically-assisted surgical expansion (EASE) for the treatment of obstructive sleep apnea". Sleep Medicine. 60: 53–59. doi:10.1016/j.sleep.2018.09.008. PMID   30393018. S2CID   53218014.
  5. ↑ Garib, Daniela G.; Henriques, José Fernando Castanha; Janson, Guilherme; Freitas, Marcos Roberto; Coelho, Regis Antonio (2005-07-01). "Rapid maxillary expansion--tooth tissue-borne versus tooth-borne expanders: a computed tomography evaluation of dentoskeletal effects". The Angle Orthodontist. 75 (4): 548–557. ISSN   0003-3219. PMID   16097223.
  6. ↑ Weissheimer, André; de Menezes, Luciane Macedo; Mezomo, Mauricio; Dias, Daniela Marchiori; de Lima, Eduardo Martinelli Santayana; Rizzatto, Susana Maria Deon (2011-09-01). "Immediate effects of rapid maxillary expansion with Haas-type and hyrax-type expanders: a randomized clinical trial". American Journal of Orthodontics and Dentofacial Orthopedics. 140 (3): 366–376. doi:10.1016/j.ajodo.2010.07.025. ISSN   1097-6752. PMID   21889081.
  7. ↑ Lin, Lu; Ahn, Hyo-Won; Kim, Su-Jung; Moon, Sung-Chul; Kim, Seong-Hun; Nelson, Gerald (2014-06-19). "Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence". The Angle Orthodontist. 85 (2): 253–262. doi: 10.2319/030514-156.1 . PMC   8631879 . PMID   25490552.
  8. ↑ Lagravère, Manuel O.; Carey, Jason; Heo, Giseon; Toogood, Roger W.; Major, Paul W. (2010-03-01). "Transverse, vertical, and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: a randomized clinical trial". American Journal of Orthodontics and Dentofacial Orthopedics. 137 (3): 304.e1–12, discussion 304–305. doi:10.1016/j.ajodo.2009.09.016. ISSN   1097-6752. PMID   20197161.
  9. ↑ Khosravi, Mahdieh; Ugolini, Alessandro; Miresmaeili, Amirfarhang; Mirzaei, Hamed; Shahidi-Zandi, Vahid; Soheilifar, Sepideh; Karami, Manoochehr; Mahmoudzadeh, Majid (2019-09-01). "Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review". International Orthodontics. 17 (3): 425–436. doi:10.1016/j.ortho.2019.06.003. ISSN   1761-7227. PMID   31280998. S2CID   195828787.
  10. ↑ Martina, R.; Cioffi, I.; Farella, M.; Leone, P.; Manzo, P.; Matarese, G.; Portelli, M.; Nucera, R.; Cordasco, G. (2012-08-01). "Transverse changes determined by rapid and slow maxillary expansion – a low-dose CT-based randomized controlled trial". Orthodontics & Craniofacial Research. 15 (3): 159–168. doi:10.1111/j.1601-6343.2012.01543.x. ISSN   1601-6343. PMID   22812438.
  11. ↑ Zhou, Yang; Long, Hu; Ye, Niansong; Xue, Junjie; Yang, Xin; Liao, Lina; Lai, Wenli (2014-04-01). "The effectiveness of non-surgical maxillary expansion: a meta-analysis". European Journal of Orthodontics. 36 (2): 233–242. doi: 10.1093/ejo/cjt044 . ISSN   1460-2210. PMID   23828862.
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