MAXILLARY EXPANSION

INTRODUCTION
• Arch Expansion is a method of gaining space in Orthodontics.
• It is one of the oldest and most conservative method of gaining space.
• It can be used to correct intermaxillary and dental arch relationships primarily in the
transverse direction. It also enables correction of crossbites early in treatment.
Classification
1. Orthodontic or dental expansion: dentoalveolar in nature and produced by
various removable expansion plates and conventional fixed appliances.
There is lateral tipping of crown and lingual tipping of roots.
2. Orthopedic or skeletal expansion- Changes produced are skeletal in nature.
Eg- Rapid maxillary expansion.
3. Passive Expansion- It is produced by shielding of buccal and labial muscles with a
resultant expansion of the arches.This type of expansion is produced by intrinsic
forces such as those produced by the tongue.
Eg- Fr-2 appliance and lip bumper.
ANATOMY
The inter-maxillary and the inter-maxillary and the inter-palatine
sutures are collectively called the mid-palatal suture.
Most of the sutural attachments of the maxilla to the adjoining bones
are at its posterior and superior aspects leaving the anterior and
inferior aspects free, which makes it vulnerable for Lateral
isplacement.
Mid Palatine Suture plays a key role in R.M.E.
i. Infancy - Y-shape
ii. Juvenile - T-shape
iii. Adolescence - Jigsaw puzzle
As sutural patency is vital to R.M.E, it is important to know when does the suture
closes by synostosis.
An average 5% of suture in closed by age 25 yrs, range of ossification between 15-
27 years
Earliest closure occurs in girls aged 15 yrs and 18 years in boys.
Greater degree of obliteration occurs posteriorly than anteriorly

RME
Also known as rapid palatal expansion or split palate.
It is a skeletal type of expansion that involves the separation of the mid-palatal
sutures and movement of the maxillary shelves away.
Emerson C. Angell is considered the father of rapid maxillary expansion. m each

INDICATIONS OF RME
Posterior crossbites..Transverse descripency is greater than 4mm and molars are already buccally tilted to
compensate for it.
• Class III malocclusion- Dental or skeletal cause.
• Cleft Palate patients
• Face mask therapy
• Medical indications- Nasal stenosis, poor nasal airway, septal deformities,allergic rhinitis.
• Selected arch length problems- In selected patients in whom extraction could lead to flattening of Profile.
Dr
MMILD crowding
Mild Shalu Jai
 C/I of RME
Single tooth crossbites
2. Uncooperative patients
3. RME is not carried out after ossification of the midpalatal suture unless accompanied by adjunctive
surgical procedures.
4. Vertical growers with steep mandibular plane. And open bite
5. Skeletal asymmetry of maxilla and mandible and adult cases with severe antero-posterior skeletal
discrepancies.
6. Periodontally weak dentition.

APPLIANCES USED
Fixed appliances- (a) Tooth borne (b)Tooth & Tissue bornen,
Appliances that are fixed onto the teeth are more reliable and found to produce consistent skeletal
effects.
• TOOTH AND TISSUE BORNE APPLIANCES
1. Derichsweiler type (HAS DE)
2. Hass type
TOOTH BORNE APPLIANCES
1. Isaacson type (ISA HY)
2. Hyrax typeSubharti Dental C

1. Derichsweiler type- The first premolars and first molars are banded. Wire tags are soldered onto
the palatal aspect of the band. These wire tags get inserted into a split acrylic plate
incorporating a screw at its centre.
2. Hass type- The 1st premolar and molar of either side are banded. A thick
stainless steel wire is soldered on the buccal and lingual aspect connecting PM and
M bands. The lingual wire is kept longer to extend past the bands. The split palatal
acrylic has a midline screw.

3. Isaacson type- This a tooth borne appliance without any acrylic palatal covering.
This design makes use of a spring loaded screw called a minne expander.

4. Hyrax type- This type of appliance makes use of a special type of screw called HYRAX ( Hygienic
rapid expander). The screws have heavy gauge wire extensions that are adapted to follow the palatal
contour and are soldered to bands on premolars and molars.

EFFECT OF R.M.E. ON THE MAXILLARY COMPLEX

• Rapid maxillary expansion occurs when the force applied to the teeth and the maxillary alveolar
processes exceeds the limits needed for orthodontic tooth movement.
• The applied pressure acts as an orthopaedic force that opens the midpalatal suture.
The appliance compresses the periodontal ligament, bends the alveolar processes, tips the anchor
teeth, and gradually opens the midpalatal suture.
OCCLUSAL VIEW • Palatine processes of the maxillae separated in a nonparallel— that is, in a wedge-
shaped

FRONTAL VIEW • The maxillary suture was found to separate superoinferiorly in a nonparallel
manner.
• It is pyramidal in shape with the base of the pyramid located at the oral side of the bone.

• From the patient's point of view, one of the most spectacular changes
ccompanying RME is the opening of a diastema between the maxillary central incisors.
EFFECT OF R.M.E. ON MANDIBULAR COMPLEX
• The mandible rotates downward and backwards due to the downward movement of the maxillary
posterior teeth in a buccal direction.
• The palatal cusps of the maxillary posterior teeth, which should ideally occlude in the occlusal
grove of the mandibular posterior teeth, tend to occlude with the lingual slopes of the buccal cusps
of these teeth, there by giving the effect of opening the bite.
EFFECT OF R.M.E. ON THE NASAL CAVITY •
The RME tends to increase the intranasal space as the outer walls of the nasal cavity move apart and
the palatal shelves flatten out, making the nasal floor broader

ACTIVATION OF THE RME APPLIANCE

• Forces generated are close to 10 to 20 pounds.
• An expansion of 0.2 to 0.5 mm should be achieved per day.
• Screw activated at between 0.5 to 1mm per day and about 1 cm of expansion can be expected in 2
to 3 weeks.
• Timms –
activation of 90° ,morning and evening - patients up to age of 15 years
In patients above this age- suggests an activation of 45° four times a day.
• Zimring and lsaacson recommended, two turns per day initial 4 to 5 days followed by one turn per
day in growing individuals.
For adults : two turns each for the first two days followed by one turn per day for the next 5 to 7 days
and then only one turn every alternate day till the desired expansion is achieved.
HAZARDS OF RME
• Oral hygiene
• Length of fixation
• Dislodgement and breakage
• Tissue damage
• Infection
• Failure of suture to open

SURGICALLY ASSISTED RAPID PALATAL EXPANSION (SARPE)

Patients who exhibit unusual resistance to separation of palatine bones may require surgical
Intervention.
This usually occurs in female patients over 16 years of age and male patients over 18 years of age.
It may also be required in patients exhibiting increased circum maxillary rigidity as a result of aging.
The main resistance to maxillary skeletal expansion comes from the buttressing effect of zygomatic
and sphenoid bones at their point of attachment to the maxilla.
SARPE involves surgical separation of these attachments thereby allowing expansion to be achieved
using a conventional RME appliance. Expansion is carried out at a rate of 0.5mm per day.
It has a high relapse tendency because of inelasticity of palatal mucoperiosteum and a degree of
overcorrection is valuable.