9Īnterior and inferior movement of the maxilla and subsequent clockwise rotation of the mandible have been reported to occur with use of the aforementioned surgical and nonsurgical procedures for maxillary expansion. The miniscrews can reduce stress on the anchor teeth when the appliance expands the maxillary arch, thus reducing the side effects on the anchor teeth. 8 reported a successful clinical outcome for a patient who underwent orthognathic surgery and tooth–bone-borne RPE, which was assisted by four palatally placed orthodontic titanium miniscrews (i.e., miniscrew-assisted RPE ).
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A transpalatal arch or conventional rapid palatal expansion (RPE) is generally not feasible in adults because of possible adverse effects such as buccal tipping, root resorption, and gingival recession around the anchor teeth. In addition, this modality lengthens the presurgical orthodontic treatment period, thus deteriorating the patient’s quality of life. 6 However, premolar extraction loses its applicability if the maxillary arch shows no or mild crowding. 4, 5įor nonsurgical expansion, clinicians can decide to extract the maxillary premolars for relative expansion of the maxillary arch during presurgical orthodontic treatment. 2, 3 Consequently, surgically-assisted rapid palatal expansion (SARPE) has been widely performed, although clinicians and patients might be concerned about additional issues such as hospitalization, attendant morbidity, increased cost, and surgical complications. However, it produces inaccurate and unstable outcomes. Surgical expansion can be achieved with segmental maxillary osteotomy, which can be performed simultaneously with bimaxillary surgery in the operating room. 1 In such cases, the clinician can address the transverse discrepancy using both surgical and nonsurgical methods. Some adult patients with skeletal Class III malocclusion exhibit severe maxillomandibular anteroposterior discrepancy with transverse maxillary deficiency, which renders the treatment more challenging. Keywords: Miniscrew-assisted rapid palatal expansion, Transverse maxillomandibular discrepancy, Skeletal Class III malocclusion, Stability Conclusions: MARPE is useful for stable and nonsurgical expansion of the maxilla in adult patients with skeletal Class III malocclusion who are scheduled for bimaxillary surgery. No significant correlations existed between the amount of maxillary expansion and postsurgical mandibular movement.
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However, there was no significant difference in surgical changes and the postsurgical stability between the two groups. Six months after surgery, the maxillary intercanine (2.7 ± 2.1 mm), interpremolar (3.6 ± 2.4 mm), and intermolar (2.0 ± 1.3 mm) arch widths were significantly increased ( p < 0.001) relative to the values before presurgical orthodontic treatment in the MARPE group these widths were maintained or decreased in the control group. Two days after surgery, the mandible had moved backward and upward without any significant intergroup difference. However, the difference of approximately 3.1 mm in the maxillomandibular intermolar width was statistically significant ( p < 0.001). Results: Before presurgical orthodontic treatment, there was no significant differences in terms of sex and age between groups.
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Serial lateral cephalograms and dental casts were analyzed until 6 months after surgery. Methods: A total of 40 adult patients with skeletal Class III malocclusion were retrospectively divided into two groups (n = 20 each) according to the use of MARPE for the correction of transverse maxillomandibular discrepancy during presurgical orthodontic treatment. Objective: The aim of this study was to evaluate the stability of bimaxillary surgery involving bilateral intraoral vertical ramus osteotomy performed with or without presurgical miniscrew-assisted rapid palatal expansion (MARPE) in adult patients with skeletal Class III malocclusion.