Orthodontic CHALLENGES with conventional Expansion,SARPE and MARPE
Channel: Junaid weblog
Date: 2020-09-22

Orthodontic CHALLENGES with conventional Expansion,SARPE and MARPE
Maxillary expansion
The transverse dimension of the maxilla can be increased in five ways: (1)
Orthodontically through dental tipping, (2) via rapid palatal orthodontic expansion in
growing patients, (3) through surgically assisted orthodontic palatal expansion in
nongrowing patients, and (4) through surgical expansion by means of segmental
surgery.( 5) by marpe 
When planning for the correction of transverse maxillary deficiency or cross bite
 the
strengths and weaknesses of each applicable option should be understood and
considered.
Maxillary transverse deficiency usually results in posterior crossbites and has an
incidence among the general population of approximately 9.4%. Because the relative
transverse dimension between the maxilla and mandible is also influenced by their
anteroposterior relationship, Jacobs and colleagues (1980) divided transverse
discrepancies into relative or absolute posterior crossbites. The determination is made
when the dental model of a patient is handheld in central relation and posterior
crossbite is evident. The models are then moved to position the dental arches into a
Class I canine relationship. If the crossbite is corrected with the anteroposterior
alignment of the arches, it is considered a relative transverse discrepancy. If the
crossbite still exists following the movement, it is considered an absolute transverse
discrepancy
An absolute posterior crossbite may occur bilaterally or unilaterally and is often
associated with a Class II anterior open bite dentofacial deformity. However, absolutecrossbites may also occur in Class I and Class III malocclusions. The etiology of
posterior crossbites may be congenital, traumatic, iatrogenic, or developmental. The
restricted transverse growth caused by surgical intervention in patients with cleft lip
and palate is an example of iatrogenic origin whereas long-term thumbsucking is a good
example of developmental etiology.
Growth of the maxilla takes place at the suture margins by deposition of new bone
from the adjacent cellular layer. The principle of orthopedic expansion of the palate
relies on the physiology of normal active growth and elasticity of the new bone at the
suture lines. Cellular activity at the suture lines decreases with age, and a wide age
range—between 16 and 35 years—before completion of the synostosis has been
reported. However, it is generally accepted that rapid palatal expansion without
surgical assistance is clinically successful only until the age of 14 to 16 years. As much
as 30% to 50% of the gain in the transverse dimension with this method can be lost as
a result of relapse, which proves that most of the width is obtained by dental tipping
and not skeletal expansion. Orthopedic expansion of the maxilla beyond the age of 16years has certain disadvantages, including severe pain, pressure necrosis of the palatal
soft tissue, dental tipping with no skeletal change, and uncontrolled relapse.
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