Pacific Coast Society of Orthodontists Bulletin Spring 2020 - 54

Doctors

is young and the palatal suture is not as well
interdigitated, the periodontal ligament (PDL)
is stronger than the midpalatal suture and the
teeth are maintained within the alveolar housing
as the suture opens with expansion. At some
point, the force required to separate the midpalatal suture becomes greater than the strength of
the PDL. "If the PDL is weaker than the midpalatal
suture, then the PDL will give, and the tooth will
move beyond the alveolar bone housing."
A systematic review published recently found
buccal bone loss associated with expansion,
but the amount of bone loss was not clinically
significant because it was less than 1 mm.1 While
this may not be clinically significant, patients
with very thin biotypes, such as phenotype B,
have a significant response to losing attachment amounts that are considered not clinically
significant. The systematic review recommended assessing gingival biotype and performing
expansion during early mixed dentition before
root resorption of the primary molars, while using
primary teeth for anchorage.
Recommendations for Expansion With Skeletal
Anchorage
▫▫ In adolescent patients younger than 14, place
two TSADs perpendicular to the long axis of
the teeth and attach acrylic pads and expander.

54

▫▫ In skeletally mature patients, it is recommend▫▫

▫▫

ed to use 4 TSADs and place them perpendicular to the superior palate.
There does not seem to be a maximum age
limit to palatal expansion with skeletal anchorage for females. The oldest case expanded was a 64-year-old woman.
Men older than 25 have been shown to have
problems with expansion techniques. The
reason is unknown but could be due to hormones.

Rationale for Implant-Assisted Expansion
▫▫ Greater velocity of skeletal expansion
▫▫ Less dental tipping
▫▫ Long-term stability
▫▫ Greater improvement in nasal resistance,
nasal score
▫▫ Improvement in obstructive sleep apnea parameters (distraction osteogenesis maxillary
expansion)
Reference
1. Lo Giudice A, Barbato E, Cosentino L, Ferraro CM,
Leonardi R. Alveolar bone changes after rapid maxillary
expansion with tooth-born appliances: a systematic
review. Eur J Orthod 2018;40:296-303.

PCSO Bulletin Spring 2020

Pacific Coast Society of Orthodontists Bulletin Spring 2020

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