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      Digital Planning and Manufacturing of Maxillary Skeletal Expander for Patients with Thin Palatal Bone

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          Abstract

          The miniscrew-assisted rapid palatal expansion approach has given new opportunities for the treatment of maxilla transverse deficiency by providing an alternative to the surgical approach for adult patients. However, the presence of a thin palatal bone can compromise the success of such approach. Recently, the digital planning of the miniscrew-assisted appliances has offered unique advantages in terms of safety and accuracy of the overall process. The aim of this study is to describe the digital planning and MSE fabrication with cad-cam technology using 6 mini-screws in cases with a palatal bone thickness of less than 2.5 mm.

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          Most cited references27

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          Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism.

          A transverse maxillary deficiency in an adult is a challenging problem, especially when it is combined with a severe anteroposterior jaw discrepancy. The demand for nonsurgical maxillary expansion might increase as patients and clinicians try to avoid a 2-stage surgical procedure-surgically assisted rapid palatal expansion followed by orthognathic surgery-and detrimental periodontal effects and relapse. In this regard, a miniscrew-assisted rapid palatal expansion was devised and used to treat a 20-year-old patient who had severe transverse discrepancy and mandibular prognathism. Sufficient maxillary orthopedic expansion with minimal tipping of the buccal segment was achieved preoperatively, and orthognathic surgery corrected the anteroposterior discrepancy. The periodontal soundness and short-term stability of the maxillary expansion were confirmed both clinically and radiologically. Effective incorporation of orthodontic miniscrews for transverse correction might help eliminate the need for some surgical procedures in patients with complex craniofacial discrepancies by securing the safety and stability of the treatment, assuming that the suture is still patent.
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            Palatal growth studied on human autopsy material. A histologic microradiographic study.

            B Melsen (1975)
            The postnatal development of the hard palate was studied by conventional histologic and microradiographic means on autopsy material from thirty-three boys and twenty-seven girls aged 0 to 18 years. The findings indicated thet growth in length of the hard palate until the age of 13 to 15 was due to growth in the transverse suture and to apposition on the posterior margin of the palate. After this age the sutural growth was found to cease, whereas the apposition seemed to continue for some years. During the postnatal development the morphology of the transverse suture changed. At birth the suture was broad and slightly sinuous; later it developed into a typical squamous suture, the palatine part covering the maxillary part. During puberty the course of the suture was again slightly sinuous. The importance of this change for the vertical growth of the hard palate was discusses. It was pointed out that the lowering of the anterior part of the palate. The transverse growth of the midpalatal suture continued up to tha age of 16 in girls and 18 in boys. On the basis of morphology, the development of the median suture could be divided into three stages. In the first stage the suture was short, broad, and Y shaped; in the second the course was more sinuous; and in the third interdigitation was so heavy that a separation of the two halves of the maxilla would not be possible without fracturing the interdigitated processes.
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              Maxillary transverse deficiency.

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                Author and article information

                Journal
                Med Devices (Auckl)
                Med Devices (Auckl)
                mder
                Medical Devices (Auckland, N.Z.)
                Dove
                1179-1470
                07 October 2021
                2021
                : 14
                : 299-311
                Affiliations
                [1 ]Department of Biomedical, Surgical and Dental Sciences, University of Milan , Milan, Italy
                [2 ]Private Dental Laboratory Practice , Castelfranco Veneto, Italy
                [3 ]Private Orthodontic Practice , Munich, Germany
                [4 ]Department of Civil, Environmental and Architectural Engineering ICEA, University of Padova , Padova, Italy
                [5 ]IRCCS Orthopedic Institute Galeazzi , Milan, Italy
                [6 ]Orthodontics, The Forsyth Institute , Cambridge, MA, USA
                [7 ]Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine , Suwon, Korea
                Author notes
                Correspondence: Daniele Cantarella Department of Biomedical, Surgical and Dental Sciences, University of Milan , via Commenda 10, Milan, Italy Email danielecant@hotmail.com
                Author information
                http://orcid.org/0000-0002-0783-541X
                http://orcid.org/0000-0001-5858-1483
                Article
                331127
                10.2147/MDER.S331127
                8504975
                34675696
                e76a8ab1-f745-4347-afa6-b968758d83b6
                © 2021 Cantarella et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 04 August 2021
                : 22 September 2021
                Page count
                Figures: 18, Tables: 2, References: 27, Pages: 13
                Categories
                Case Series

                Biotechnology
                digital orthodontics,mse,maxillary transverse deficiency,palatal expansion,marpe
                Biotechnology
                digital orthodontics, mse, maxillary transverse deficiency, palatal expansion, marpe

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