## 4 Discussion
\begin{table}
\begin{tabular}{c c c c c} \hline \hline \multirow{2}{*}{**Diastema**} & \multicolumn{4}{c}{**Sex**} \\ \cline{2-5}  & \multicolumn{2}{c}{**Female (_n = 21_)**} & **Male (_n = 18_)** & \(p\) \\ \hline \multirow{2}{*}{Diastema after 1 week} & no & 6 (29\%) & 10 (56\%) & \(p\) = 0.167 \\ \cline{2-5}  & yes & 15 (71\%) & 8 (44\%) & \\ \hline \multirow{2}{*}{Diastema after 2 weeks} & no & 1 (5\%) & 7 (39\%) & \(p\) = 0.015 * \\ \cline{2-5}  & yes & 20 (95\%) & 11 (61\%) & \\ \hline \hline \end{tabular} \(p\): chi-squared test or [PERSON]’s exact test. * Statistically significant differences (_p_ < 0.05).  
\end{table} 
Table 4: Distraction results in all patient groups. a biological reaction in which inflammation activates osteoclasts (as a catabolic reaction to tensile transverse forces) in the first period of distraction, which takes a month before the process of bone separation begins. Osteoblasts are then activated in response to the number of osteoclasts. In the next step, new bone is produced. The contribution of the inflammation process was confirmed in the control group of rats, which were medicated with anti-inflammatory; a decrease in osteoblast activity was observed in them. This confirmed the result of a previous study by [PERSON] et al. (2015). These studies show that there is a need to pay attention to the painkillers patients are taking in order to ensure they have no anti-inflammatory component. [PERSON] et al. (2015) also considered previous research conducted on dry skulls and finite elements ([PERSON] et al., 2015; [PERSON] et al., 2015), where the palatal suture bone distraction was described in terms of transversal tensile forces, without taking into account the biological reaction. On the other hand, they noted that the smaller initial sutural width in adult patients means that the osteoclast activation time may be longer; this suggests that strong forces over short periods are contraindicated in that group of patients. Based on this research, [PERSON] et al. (2015) suggested that, even if distraction fails in the initial stage of expansion, activation of the catabolic phase after a resting period of approximately one month can allow the suture to be separated after the resumption of expansion. Similarly, the unexplored biological reaction could be associated with sex hormones, which can play an important differentiating role in sex-specific reactions to distraction forces in suture soft tissue. The research of [PERSON] et al. (2015) used only female rats, so sex differences were not examined. It is also worth noting that, in our study group of men who did not develop maxillary distraction, we recommended stopping the daily activation by changing the maintenance protocol to activation once a week and setting the next visit for a month later. All patients in whom this type of emergency protocol was implemented returned to us after a month with visible diastema. They reported that they went to bed in the evening with noticeable tension, that in the morning they no longer felt tension, and that they noticed the diastema in the mirror when they first visited the bathroom. Our retrospective research has shown that there are correlations between sex and age on one hand and the success rate of palatal expansion on the other, but future prospective studies are necessary to optimize the frequency of activation, given need to limit the induced force. The effectiveness of the distraction procedure in adolescents is positive, regardless of sex. However, in adults, the procedure has limited effectiveness in males. This is also important for predictions of orthodontic treatment plans.