You are on page 1of 11

ORIGINAL ARTICLE

Immediate effects of rapid maxillary expansion with Haas-type and hyrax-type expanders: A randomized clinical trial 
Andre Weissheimer,a Luciane Macedo de Menezes,b Mauricio Mezomo,a Daniela Marchiori Dias,a Eduardo Martinelli Santayana de Lima,b and Susana Maria Deon Rizzattoc Porto Alegre, Rio Grande do Sul, Brazil Introduction: The purposes of this study were to evaluate and compare the immediate effects of rapid maxillary expansion (RME) in the transverse plane with Haas-type and hyrax-type expanders by using cone-beam computed tomography. Methods: A sample of 33 subjects (mean age, 10.7 years; range, 7.2-14.5 years) with transverse maxillary deficiency were randomly divided into 2 groups: Haas (n 5 18) and hyrax (n 5 15). All patients had RME with an initial activation of 4 quarter turns followed by 2 quarter turns per day until the expansion reached 8 mm. Cone-beam computed tomography scans were taken before expansion and at the end of the RME phase. Maxillary transversal measurements were compared by using the mixed analysis of variance (ANOVA) model and the Tukey-Kramer method. Results: RME increased all maxillary transverse dimensions (P \0.0001). There was less expansion at skeletal than dental levels. The hyrax group had greater statistically significant orthopedic effects and less tipping tendency of the maxillary first molars compared with the Haas group. Conclusions: Both appliances were efficient in correcting a transverse maxillary deficiency. The pure skeletal expansion was greater than actual dental expansion. The hyrax-type expander produced greater orthopedic effects than did the Haas-type expander, but this effect was less than 0.5 mm per side and might not be clinically significant. (Am J Orthod Dentofacial Orthop 2011;140:366-76)

R

apid maxillary expansion (RME) is an important method used to correct a transverse maxillary deficiency. It was first described in the literature over a century ago by Angell,1 and it has been disseminated and made widely popular by Haas since 1961.2 In RME, rigid and fixed expanders are used to produce heavy forces to obtain the maximum skeletal response by opening the midpalatal suture, with minimum orthodontic movement.2-5 Among the appliances used for RME, the toothtissue–borne (Haas-type) and the tooth-borne (hyraxtype) expanders are the most recognized in the literature. The main difference between them is the acrylic pad that leans on the lateral walls of the palatal vault (Haas-type)

From the Department of Orthodontics, Pontifical Catholic University of Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil. a Postgraduate student (Ph.D.). b Professor. c Assistant professor. The authors report no commercial, proprietary, or financial interest in the products or companies described in this article. Reprint requests to: Andr Weissheimer, Pontif Universidade Catlica do Rio e ıcia o Grande do Sul, Faculdade de Odontologia, Prdio 6, Avenida Ipiranga, 6681, sala e 209, Porto Alegre, RS, Brazil, CEP 90619-900; e-mail, andre5051@hotmail.com. Submitted, March 2010; revised and accepted, July 2010. 0889-5406/$36.00 Copyright Ó 2011 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2010.07.025

to reinforce the anchorage for greater orthopedic response and better force distribution during RME.2,4 In the hyrax-type expander, there is no acrylic pad; therefore, it is more hygienic and prevents soft-tissue irritation caused by food impaction under the acrylic plate.6 Although a cephalometric investigation has not demonstrated any differences between Haas-type and hyrax-type expanders,7 there is no consensus in the literature regarding the differences in the immediate RME effects produced by these appliances. Several investigations have analyzed the effects of RME through 2-dimensional cephalometric radiographs, which do not allow accurate identification of dentoskeletal structures because of the superimposition of many bones in the different planes of space.2,7-9 To overcome these limitations, computed tomography (CT) for the assessment of the transverse dimensions of the maxilla was introduced by Timms et al10 in the 1980s. However, the use of conventional CT scans in orthodontics has been limited because of cost and radiation concerns.11 Cone-beam CT (CBCT) has ushered in a new era in dental diagnostics. This technology was designed for imaging hard tissues of the maxillofacial region with minimum distortion at a lower cost and with lower radiation emissions compared with

366

125 mm. which produces submillimeter resolutions ranging from 0. American Journal of Orthodontics and Dentofacial Orthopedics September 2011  Vol 140  Issue 3 .16.11 Several investigations have shown the high accuracy of CBCT images for quantitative and qualitative analyses.19 and evaluation of RME effects on nasomaxillary structures. C and D. preexpansion.18 analysis of alveolar bone before placement of orthodontic temporary anchorage devices. at the end of the active phase of expansion. Fig 2. The high resolution of CBCT images is due to the isotropic voxel (equal in all 3 dimensions).17 evaluation of bone grafts in cleft regions. A.Weissheimer et al 367 Fig 1. Haas-type expander and B. conventional CT.4 mm to as low as 0.20 The purposes of this study were to evaluate and compare the immediate effects of RME on the transverse plane with Haas-type and hyrax-type expanders by using high-resolution CBCT. Transverse maxillary posterior region evaluation: A and B. hyrax-type expander at the end of the active phase of RME.12-15 Its use is recommended in orthodontics for several purposes such as evaluation of impacted teeth.

the DICOM files with CBCT images at T1 and T2 were imported into EFILM and visualized as axial images arranged side by side.2-mm expansion. and no surgical or other treatment that might affect the RME effects during the expansion period. In this prospective study.4-mm stainless steel extensions soldered to the lingual surfaces of each pair of bands.8-15 years). Landmarks used in the evaluation of the maxillary posterior region. buccal and lingual stainless steel bars of 1. scan time of 40 seconds. In the September 2011  Vol 140  Issue 3 American Journal of Orthodontics and Dentofacial Orthopedics .3-mm slice thickness. 22 girls) with a mean chronologic age of 10. These patients were randomly divided into 2 groups: Haas (n 5 18) and hyrax (n 5 15). with initial activations of 4 quarter turns (0. Both appliances had expansion jackscrews with activations of a quarter turn equivalent to a 0. 8 mA. Informed consent was obtained from the parents of all patients who agreed to participate in this study. Milwaukee. Merge Healthcare. Patients with congenital malformations or periodontal diseases.0-mm diameter was used (Fig 1. and 0.9 years (range. A). Hatfield.2-14. The CBCT scans were performed at 120 kV. the hyrax-type expander. was used (Fig 1. or above 15 years of age were excluded from the study sample.M. The i-CAT (Imaging Sciences International. 7. The sample was selected by examining subjects in need of orthodontic treatment at the Department of Orthodontics of the School of Dentistry. with 4 bands (first permanent molars and first premolars or first deciduous molars) and buccal and lingual stainless steel bars of 1.7 years (range. who had no access to the data or the clinical consultations of the patients in this sample. Pa) was used to obtain CBCT images before RME (T1) and at the end of the active expansion phase (T2). The inclusion criteria for this study were transverse maxillary deficiency.2. with 4 bands.). The data for each patient were reconstructed with 0. MATERIAL AND METHODS This study was approved by the ethical committee of the Pontifical Catholic University of Rio Grande do Sul in Brazil. In the Haas group.3-mm voxel dimension. B). In the hyrax group. the sample comprised 33 healthy white children (11 boys. the Haas-type expander.4 mm) until the expansion screw reached 8 mm. and the digital imaging and communications in medicine (DICOM) images were assessed by using the EFILM workstation software program (version 2.1.5 years) and a mean skeletal age of 10. For transverse maxillary posterior region evaluation.368 Weissheimer et al Fig 3. the following references were used.8 mm) followed by 2 quarter turns per day (0. To obtain standardized axial and coronal slices and thus allow the comparisons between T1 and T2. All linear and angular measurements were made by a blinded examiner (M. 6.0-mm diameter and a jackscrew with 1. All patients in the Haas and hyrax groups had RME. Wis). mixed dentition or early permanent dentition.

respectively). the images that displayed the root canal in the most apical region of the palatal root of maxillary first permanent molars were selected. After that. respectively). on the right and left sides. Distance between points 7 and 8 (points formed by the intersection of a straight line. Landmarks for transverse maxillary evaluation Skeletal Line 1-2 Line 13-14 Distance 5-6 Posterior baseline Anterior baseline Posterior apical base width Line formed by the 2 lower points at the inferior inner contour of the posterior nasal cavity on the right and left sides. From theses references. The landmarks used for evaluation of the maxillary posterior region are shown in Figure 3 and described in Table I. the MultiPlanar Reformation line was positioned at the root canal in the most apical region of the maxillary permanent canine root on the right and left sides. Double assessments of each parameter at T1 and T2 (10 days apart) of 15 randomly selected patients from both groups were compared (Table II). Cary.2. on the left side. The analyses of the transversal changes in the maxillary anterior region were performed in a similar way to those of the posterior region. respectively). on the right and left sides.0. Distance between points 19 and 20 (intersection of the straight line. respectively). which is parallel and 5 mm inferior to line 13-14. From these references. and the measurements were made (Fig 4). By using the MultiPlanar Reformation tool. with buccal contour of maxilla on the right and left sides. standardized coronal images were produced. Distance 11-12 Posterior midpalatal suture width Distance 15-16 Anterior apical base width (inferior) Distance 17-18 Anterior apical base width (superior) Distance 21-22 Anterior mid-palatal suture width Alveolar Distance 3-4 Distance 19-20 Posterior width at the alveolar crest level Anterior width at midalveolar level Dental Distance 7-8 Intermolar width at occlusal surface Distance 9-10 Angle 1MD Intermolar width at palatal root apices Right first molar angulation Left first molar angulation Angle 1ME axial slices. respectively). SAS. Distance between points 3 and 4 (coronal-most points of the maxillary buccal alveolar processes. standardized coronal images were produced. images at T1 and T2 were selected with the root canals in the most apical region of the roots of the maxillary permanent canines visualized. Means and standard errors for each parameter were calculated. Statistical analysis Intraexaminer reliability of the measurements was determined by intraclass correlation coefficients. respectively). Distance between points 5 and 6 (points formed by the intersection of the line 1-2 with buccal contour of maxilla on the right and left sides. respectively). and the measurements were made (Fig 2).Weissheimer et al 369 Table I. which is parallel and 5 mm superior to line 13-14. respectively). Distance between points 9 and 10 (apices of palatine root of permanent first molars. Distance between points 17 and 18 (intersection of the straight line. on the right side. Angle formed by the straight line from point 7 and that superimposes the long axis of the root canal of permanent first molar palatine root. Distance between points 21 and 22 (lower points at medial limits of maxillary palatine processes. on the right and left sides. Distance between points 11 and 12 (lower points at medial limits of maxillary palatine processes. NC). the MultiPlanar Reformation line was positioned at the root canal in the most apical region of the palatal root of the maxillary first permanent molars on the right and left sides. with the occlusal surface on the right and left sides. The landmarks used to evaluate the RME effects in the anterior region of maxilla are shown in Figure 5 and described in Table I. In the axial slices. Angle formed by the straight line from point 8 and that superimposes the long axis of the root canal of permanent first molar palatine root. The data obtained from all measurements were processed with SAS software (version 9. Distance between points 15 and 16 (points formed by the intersection of line 13-14 with buccal contour of maxilla on the right and left sides. with the line 1-2. representing the midpalatal suture. with buccal contour of maxilla on the right and left sides. Line formed by the 2 lower points at the inferior inner contour of the anterior nasal cavity on the right and left sides. respectively. with line 1-2. and data at T1 American Journal of Orthodontics and Dentofacial Orthopedics September 2011  Vol 140  Issue 3 . on the right and left sides. representing the midpalatal suture in the anterior region. that superimpose the long axis of the root canal of first permanent molar palatine root. respectively). respectively.

RESULTS linear measure (distance 9-10). at a lower cost and with lower radiation dosages than conventional CT.25.370 Weissheimer et al Fig 4.05). preexpansion.11. There was no significant difference between the groups for the buccal inclination of the maxillary first permanent molars.22 The major problem associated with cephalometry is projection errors. Transverse maxillary anterior region evaluation: A and B. CBCT was used because it is a suitable examination for imaging craniofacial areas. just as the increase in the maxillary apical base was smaller in the posterior region (distances 5-6 and 11-12) compared with the anterior (distances 15-16.3. CBCT is an accurate and reliable method for assessing changes associated with RME on nasomaxillary structures. the immediate effects of RME on the transverse planes with Haas-type and hyrax-type expanders. alveolar. several investigations have analyzed the effects of RME through cephalometry in 2-dimensional radiographs. using highresolution CBCT.26 In addition. caused by magnification and distortion and are compounded by incorrect patient positioning. There was less expansion at the skeletal than at the dental level.23. There were significant increases in maxillary width at the skeletal. except for the After Broadbent21 introduced the cephalostat in 1931.20 September 2011  Vol 140  Issue 3 American Journal of Orthodontics and Dentofacial Orthopedics . and T2 were compared by using the mixed analysis of variance (ANOVA) model and the Tukey-Kramer method at a significance level of 5%. The hyrax group had greater statistically significant increases in the maxillary transverse dimensions at the skeletal level than did the Haas group in both posterior (distances 5-6 and 11-12) and anterior (distance 2122) regions (Table VI). DISCUSSION The overall immediate effects of RME on the transverse plane are shown in Table III. 21-22) (Tables III-V). which indicated greater inclination of these teeth in the Haas group than in the hyrax group (Table VI). we evaluated and compared. and dental levels for both the Haas (Table IV) and the hyrax (Table V) groups in all parameters (P \0.8. C and D.24 To overcome these limitations. at the end of the active phase of expansion. with minimum distortion. which have an effect on linear and angular measurements.

Intraclass correlation coefficients of the mea- surements Measurement Distance 5-6 Distance 11-12 Distance 15-16 Distance 17-18 Distance 21-22 Distance 3-4 Distance 19-20 Distance 7-8 Distance 9-10 Angle 1MD Angle 1ME ICC 0. confirming previous reports.97 0. the direction of the expansion force produced by the expanders would be located anterior to the center of resistance of each maxillary half.20.98 0. In the Haas group.37 mm (distance 21-22)—than did the Haas-type expander— 2.48 mm (distance 15-16).93 0.88 mm (distance 11-12) (Table III). In this study. ranging from 27.28. the increases were smaller.82 mm (distance 17-18). (2) the patients were randomly divided between the groups.64 mm (distance 5-6) and 2. The skeletal gain in the hyrax group accounted for 38.10. our study had an adequate sample size (33 subjects). and (4) it used highresolution CBCT.20.95 0.98 0.2% (posterior region) and 37.36 The hyrax-type expander produced greater skeletal expansion—3.74 Regarding previous reports that used CT images to evaluate RME.61 0. In agreement with previous authors.7% in the posterior region American Journal of Orthodontics and Dentofacial Orthopedics September 2011  Vol 140  Issue 3 . since the active expansion phase lasted only 19 days. this study design had some important features: (1) it was a prospective study.7% (anterior region) of the total expansion (8 mm). there was no need to use a control group without treatment since normal growth was not an influencing factor in this short time. the overall effects of RME produced a significant skeletal increase in the transverse maxillary dimension.2% to 32.5% to 39. and 4 mm (distance 21-22)—compared with the posterior—2.63 mm (distance 21-22) (Table VI).96 0.2-5. Table II.5% to 54.14 mm (distance 11-12) and 4. 3.94 0. In this study. and rate and amount of expansion.95 0.20.35 The greater expansion in the anterior region could be explained by the resistance of the medial and lateral pterygoid plates of the sphenoid bone to the maxillary tip movement during the RME.62 mm (distance 11-12) and 3.35 The skeletal expansion amounts were greater in the anterior region—2.96 0.34. (3) the methodology was highly standardized in terms of appliance fabrication. Landmarks used in the evaluation of the maxillary anterior region.27-33 Furthermore.Weissheimer et al 371 Fig 5.29.35 Another feasible explanation would be through maxillary expansion biomechanics: ie.30. the expansion pattern was triangular with a wider base at the anterior portion of maxilla.

the results of our study did not support this theory.88 3. appliance designs that use an acrylic interface with the teeth are far less stiff than those constructed solely of soldered stainless steel wire.8 0.0001* \0. thus averting an orthopedic relapse of the expanded maxilla.61 0.0001* \0.00 0. with the immediate effects of RME on 33 patients evaluated.83 0.0001* \0.0 mm) to the jackscrew.0001* and 32.63 4.80 2. which reduced the power of the t test to show statistically significant differences.11 0.51 29.14 0.37 Siqueira et al7 compared the Haas-type and hyrax-type expanders through frontal cephalometric radiographs and found no differences between them.78 04.23 0.65 40.82 4. In the hyrax-type appliance design. However.96 00. However.64 2.83 0. the acrylic pad against the palate would be important.08 0.52 1.64 0.17 0. as in the case of the hyrax-type expander.10 62.23 0.00 0.15 0.74 0.51 0.7% to 45.0001* \0. Mean SE Mean T2 SE Change Mean SE P 60. However.28.36 However.48 2.4 1.5.37 38.09 0. This phenomenon could be explained by the small study sample (n 5 8).20 September 2011  Vol 140  Issue 3 American Journal of Orthodontics and Dentofacial Orthopedics .7 0.2 51.31 32. These comparison results between the appliances differ from previous reports.52 1. where the acrylic was responsible for connecting the stainless steel framework (1.58 57.61 0.29 00.06 0. When significant differences are demonstrated in such situations.4 mm). The main difference between Haas-type and hyraxtype expanders is the acrylic pad close to the palate in the Haas-type appliance. especially during the retention period.2 7. when it would prevent the bone from moving through the teeth.0001* \0.16 0.6 117.53 6.44 0.0001* \0. According to a previous study about the biomechanics of RME.2% in the anterior region. the absence of significant differences does not necessarily indicate that they do not exist.65 7.46 0. In addition.7.58 5.4 a purpose of the acrylic pad is to reinforce the anchorage for greater orthopedic response during RME. Immediate changes in the maxillary transverse plane with RME T1 Variable Skeletal Distance 5-6 (mm) Posterior apical base width Distance 11-12 (mm) Posterior midpalatal suture width Distance 15-16 (mm) Anterior apical base width (inferior) Distance 17-18 (mm) Anterior apical base width (superior) Distance 21-22 (mm) Anterior midpalatal suture width Alveolar Distance 3-4 (mm) Posterior width at alveolar crest level Distance 19-20 (mm) Anterior width at midalveolar level Dental Distance 7-8 (mm) Intermolar width at occlusal surface Distance 9-10 (mm) Intermolar width at palatal root apices Angle 1MD ( ) Right first molar angulation Angle 1ME ( ) Left first molar angulation *Statistically significant (P \0.64 0.51 0.85 41.1 123. In disagreement with the present study.0001* \0.11 2.4. According to Haas. unlike the Haas-type appliance design. Oliveira et al37 found that the Haas-type expander achieved expansion with a greater component of orthopedic movement than the hyrax-type expander.22 \0.00 38.40 0. in the connection mechanism of the jackscrew to the bands of the anchorage teeth.4 1.86 41.90 110. Better results in the immediate skeletal response were obtained by the hyrax-type expander vs the Haastype.68 \0.00 0. at least regarding the immediate effects of expansion.28 44. the comparison between the 2 kinds of expanders was performed on study models and anteroposterior cephalograms. unlike our study. Garib et al28 also found no differences between these 2 expanders using spiral CT. the RME changes were analyzed 3 months after the active expansion phase.93 02.44 0.05).0001* \0.0001* 51.372 Weissheimer et al Table III.55 118. the jackscrew was directly connected to the bands by a rigid stainless steel framework (1.0001* 43.13 \0.08 0. they clearly exist and most likely have clinical importance. This fact can be explained by differences in appliance design: more specifically.

12 0.11 0.98 39.15 44.72 0.0001* 43.42 30.35 0.82 1.15 63.87 1.22 00.05).37 0.63 0.66 3.75 7.31 0.19 2.80 4.05).87 0.12 0.73 0.16 62.71 7.92 0.59 0.42 41.23 0.0001* Table V.00 0. to the posterior.17 \0.59 0.34 0.57 0.30 \0.33 03.0001* \0.69 0.62 0.56 0.50 32.24 0.79 57. American Journal of Orthodontics and Dentofacial Orthopedics September 2011  Vol 140  Issue 3 .14 3.19 0.00 4.18 \0.11 0.61 42.0001* \0.0001* 51.37 mm (distance 21-22).28 42. Immediate changes in the maxillary transverse plane with RME in the Haas group T1 Variable Skeletal Distance 5-6 Posterior apical base width Distance 11-12 Posterior midpalatal suture width Distance 15-16 Anterior apical base width (inferior) Distance 17-18 Anterior apical base width (superior) Distance 21-22 Anterior midpalatal suture width Alveolar Distance 3-4 Posterior width at alveolar crest level Distance 19-20 Anterior width at midalveolar level Dental Distance 7-8 Intermolar width at occlusal surface Distance 9-10 Intermolar width at palatal root apices *Statistically significant (P \0.0001* \0.16 3. This sutural orthopedic separation accounted for 54.0001* \0.0001* In the hyrax group.87 0.0001* \0. Mean (mm) SE (mm) T2 Mean (mm) SE (mm) Change Mean (mm) SE (mm) P 59.15 2.44 4.10 00. the transverse expansion at the suture gradually decreased from the anterior.14 0.82 1.71 51.92 0.83 5.73 0.69 0.14 mm (distance 11-12) (Table V).28 0.14 41.0001* \0.58 03.00 38.87 1.59 0. by 4.79 5.62 3.0001* \0.0001* \0.70 00.38 0.76 0.0001* 51. by 3.83 57.37 0.34 0.Weissheimer et al 373 Table IV.0001* \0.15 0.75 38.25 0.14 0.19 0.63 0.29 2.41 44.0001* 43.15 0.90 3.0001* \0.22 04.03 0.29 02.70 2.12 0.62 3.12 32.34 39.12 0. Mean (mm) SE (mm) T2 Mean (mm) SE (mm) Change Mean (mm) SE (mm) P 61.7% and 39.00 0.48 00.96 40.17 0.62 0.0001* \0.0001* \0.58 0.12 0.60 29.00 37.21 \0.20 0.75 51.30 0.10 3.20 \0.34 \0. Immediate changes in the maxillary transverse plane with RME in the hyrax group T1 Variable Skeletal Distance 5-6 Posterior apical base width Distance 11-12 Posterior midpalatal suture width Distance 15-16 Anterior apical base width (inferior) Distance 17-18 Anterior apical base width (superior) Distance 21-22 Anterior midpalatal suture width Alveolar Distance 3-4 Posterior width at alveolar crest level Distance 19-20 Anterior width at midalveolar level Dental Distance 7-8 Intermolar width at occlusal surface Distance 9-10 Intermolar width at palatal root apices *Statistically significant (P \0.2% of the total expansion (8 mm) at distances 21-22 and 11-12.

there was no need to remove the appliances before the CBCT examination at T2 because of the lower level of metal artifacts produced by CBCT compared with conventional CT.63 0.10 3.11 1.88 mm in the posterior and 4 mm in the anterior regions) were greater than the amounts reported by Podesser et al30 (1.007* 5. 36% of which represents sutural expansion and 34% is purely alveolar bending toward the buccal aspect.334 0.526 0.28.34 0.15 mm) regions. where the expansion accounted for 97% (distance 7-8) of the total expansion September 2011  Vol 140  Issue 3 American Journal of Orthodontics and Dentofacial Orthopedics . unlike our study.02 0. which had less anchorage.14 0.20. where the immediate effects of RME were evaluated.0008* 0.14 3. this result agrees with previous reports. and less sutural expansion was obtained in both the anterior (2.14 0.29.20 However.70 2.21 1.30 In a study by Lione et al.34 0.15 0. In our investigation.30 0. This investigation showed a more significant skeletal response compared with other studies.03 0.5 mm in the anterior regions).17 0.00 4. Mean SE Mean Hyrax group T2-T1 SE P 2.38 The greater amounts of expansion at the alveolar level (distances 3-4 and 19-20) than the sutural expansion (distances 11-12 and 21-22) (Table III) show the bending of the alveolar processes of the maxilla. the amounts of sutural expansion (2.62 3.18 0. This small orthopedic effect could be explained by (1) the use of a modified hyrax-type expander.15 8. Comparison between the changes in the maxillary transverse planes in the groups Haas group T2-T1 Variable Skeletal Distance 5-6 (mm) Posterior apical base width Distance 11-12 (mm) Posterior midpalatal suture width Distance 15-16 (mm) Anterior apical base width (inferior) Distance 17-18 (mm) Anterior apical base width (superior) Distance 21-22 (mm) Anterior midpalatal suture width Alveolar Distance 3-4 (mm) Posterior width at alveolar crest level Distance 19-20 (mm) Anterior width at midalveolar level Dental Distance 7-8 (mm) Intermolar width at occlusal surface Distance 9-10 (mm) Intermolar width at palatal root apices Angle 1MD ( ) Right first molar angulation Angle 1ME ( ) Left first molar angulation *Statistically significant difference (P \0.6 mm in the posterior and 1. (2) less total expansion (7 mm).23 0.19 0.0002* 0. In our investigations.30 5.119 7. of the total expansion achieved.80 4.438 0.17 3.12 0. The great changes in maxillary transverse dimensions occurred at the dental level.44 4.80 6.427 0.975 respectively.29 2.010* 0.25 6.35 0.17 mm) and the posterior (1. and (3) the sutural expansion evaluated in a more posterior region (posterior nasal spine) than in our study (in the first molar region). These findings endorse a previous report in which.76 0.31 0.29 the RME was performed with a modified hyrax-type expander (bands on the first permanent molars only). the RME changes were analyzed 3 months after the active expansion phase.19 2.374 Weissheimer et al Table VI.66 3.98 0. the hyrax-type expander produced 55% of the suture expansion in the anterior and 38% in the posterior regions.90 7.28 0.30 The expansion at the alveolar level (distance 3-4) accounted for 70% of the total expansion. This difference could be explained by less total expansion (7 mm) and the relapse that might have occurred because of appliance removal and replacement at the end of the active phase of RME for CT scan acquisition in their study.05).37 0.11.90 3.14 6.25 0.62 3.20 0.20 0.342 0.

only 27% (2.19 on the left sides. Three-dimene sional accuracy of measurements made with software on cone-beam computed tomography images. However.72:75-80. especially during the retention and postretention phases of RME. Angle Orthod 1961. A new volumetric CT machine for dental imaging based on the cone-beam technique: preliminary results. Skeletal and dental changes after maxillary ¸ expansion in the mixed dentition. Tinazzi Martini P. Am J Orthod Dentofacial Orthop 2004. J Clin Orthod 1968. in the Haas group. Haas AJ. The hyrax-type expander produced greater orthopedic effects in 3 of the 5 skeletal points measured compared with the Haas-type expander. Haas AJ.21 left side). 3.126:569-75. Scarfe WC. CONCLUSIONS 1. 6.31:73-90. The amounts of buccal tipping of the first permanent molars for the Haas group were 8. Scheetz JP.3.17 mm) represents actual dental expansion. 8. Farman AG.37 However.4. Hilgers ML. Angle Orthod 1980. A hygienic appliance for rapid expansion. Lagravre MO. Tacconi A. A computed tomographic assessment of maxillary movement induced by rapid expansion—a pilot study.4:123-7. Long-term posttreatment evaluation of rapid maxillary expansion. 5. and transverse dimensions after rapid palatal expansion. Eur J Orthod 1982.14 mm. The opening of the midpalatal suture accounted for 50% of the total expansion (8 mm) in the anterior region and 36% in the posterior region (there was a decrease from anterior to posterior).75 mm) of pure alveolar bending. Treatment of irregularities of the permanent or adult tooth. accounting for 7. Angell EH. Biederman W. However. Dent Cosmos 1860:540-4. This greater expansion at the dental level compared with the skeletal level agrees with previous reports. the actual dental expansion can be found by subtracting the total expansion at the dental level (distance 7-8) from the suture and alveolar expansions (distance 3-4).5 mm per side and might not be clinically significant.12 right side. We assessed the immediate effects of RME. Haas AJ.88 mm) of pure skeletal expansion (distance 11-12) and with 34% (2. Clinical applications of cone-beam computed tomography in dental practice.2:67-70. Rev Dent Press Ortodon Ortop Facial 2002. Mozzo P.14 on the left side (angle 1ME).28. Accuracy of linear temporomandibular joint measurements with cone beam computed tomography and digital cephalometric radiography.7: 27-47.128:803-11.8 mm) of the total expansion at the dental level (distance 7-8). RME produced significant increases in all maxillary transverse dimensions. whereas. the tipping amounts were 6. which represents the distance between the apices of the palatal roots of the first permanent molars. whereas. distance 9-10 increased by 3.80 on the right and 6.25 on the right side (angle 1MD) and 6. The expansion pattern was triangular. 8:1558-64. Haas AJ. Farman AG. there was a statistically significant difference between the Haas and hyrax groups in the linear measurement (distance 9-10). In the hyrax group. 13. Procacci C. Siqueira D. REFERENCES 1. Am J Orthod Dentofacial Orthop 2008. Toogood RW.35:200-17. The treatment of maxillary deficiency by opening the midpalatal suture. Angle Orthod 1965. However. these differences were not considered statistically significant in either study. Henriques J.94 right side. 14.28 the Haas-type expander produced greater buccal tipping of the first permanent molars (3. Almeida R.5 ) than did the hyrax-type expander (1. Sandikciolu M. Bergamo Andreis IA. the pure skeletal expansion was greater than actual dental expansion. Similar results were reported in other investigations. showing greater tipping of the first permanent molars with that expander (Table VI). Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. 4. Eur Radiol 1998. However. Thus.57:219-55.34. RME produced significant buccal tipping of the first permanent molars. Daly PF.53 (angle 1MD) on the right side and 6. from 97% (7. Am J Orthod Dentofacial Orthop 2005. Font B. therefore. Oliveira et al37 found that the Haas-type expander produced greater buccal tipping of the first permanent molars (7. Chung CH. 7. the effects were less than 0. 2. in the hyrax group. The sutural expansion showed a wedge shape with the wide base in the anterior maxilla.15 mm. the following conclusions can be drawn: American Journal of Orthodontics and Dentofacial Orthopedics September 2011  Vol 140  Issue 3 . 12. 11. 6. Sukovic P. Am J Orthod Dentofacial Orthop 1997. Major PW. Scarfe WC. Palatal expansion: just the beginning of dentofacial orthopedics.20. 9. Am J Orthod 1970. 599-601.111:321-7. J Can Dent Assoc 2006. with smaller effects at the skeletal level than at the dental level. 10. Carey J.Weissheimer et al 375 (8 mm) (Table III).6 ).30. Hazar S. Skeletal and dental changes in the sagittal. Based on this clinical trial with CBCT to assess the immediate effects of RME on the transverse plane with 2 kinds of palatal expanders. there was an increase of 2.64 left side) compared with the Hyrax-type expander (6. The higher values for distance 9-10 (nearly 8 mm of expansion) reflected a small buccal tipping of the first molars. 1.50:189-217. Timms DJ. Frontal cephalometric comparative study of dentoskeletal effects produced by three types of maxillary expanders. which was smaller compared with 36% (2.28-37 In the study of Garib et al. 2. Preston CB. 3.17 (angle 1ME) on the left side (Table III).134:112-6. vertical. There were no statistically significant differences between the 2 groups in angular measurements. long-term evaluation is necessary for a better understanding of the differences between Haas-type and hyrax-type expanders.

Williams S. 19. Evaluation of the effects of rapid maxillary expansion in growing children using computer tomography scanning: a pilot study. Eliasson S. Mah J. Radiation dose in dental radiology. Meta-analysis of e immediate changes with rapid maxillary expansion treatment.76:191-7.125:512-5. Franchi L. Maxillary expansion: clinical implications. Welander U. Angle Orthod 2009. Heo G. 23. Major PW. Braun S. Dougherty H Sr. Kondoh T. Coelho RA. Yi ES. 129:749-58. Angle Orthod 2006. 26. Legan HL. Ballanti F.42:128-37. “Safe zones”: a guide for miniscrew positioning in the maxillary and mandibular arch. Rapid maxillary expansion—tooth tissue-borne versus tooth-borne expanders: a computed tomography evaluation of dentoskeletal effects. 21. 34. The biomechanics of rapid maxillary sutural expansion. Shimizu N. Ballanti F. Kim J. Mobes O. Misch KA. Cohnen M. Crismani AG. Kemper J. 30. 29:37-44. 22. Walker L. Poggio PM. Viana G. Immediate and post-retention effects of rapid maxillary expansion investigated by computed tomography in growing patients. Eliasson S. 24. Stanley RN. Lunazzi JJ. Ahlqvist J. 31. Baccetti T. 17.1:45-66. 18. Benner KU. Am J Orthod Dentofacial Orthop 2006. Nakajima A. Three-dimensional assessment of morphologic changes of the maxilla: a comparison of 2 kinds of palatal expanders. Am J Orthod Dentofacial Orthop 2005. 37. Broadbent BH. Lee KG. J Am Dent Assoc 2006.134:389-92. Caruso JM. Application of limited cone beam computed tomography to clinical assessment of alveolar bone grafting: a preliminary report. Am J Orthod Dentofacial Orthop 2007.12:634-7.137:44-53. Am J Orthod Dentofacial Orthop 1987. Angle Orthod 2005. 16. Two. Hazar S. High-resolution multislice computerized tomography with multiplanar and 3-dimensional reformation imaging in rapid palatal expansion. Garib DG.77:1261-6.75:895-903.111:321-7. 20. 10:353-61. Welander U. Angle Orthod 2005. The effect of projection errors on angular measurements in cephalometry. Homme Y. Velo S. Diagnosis goes digital. Am J Orthod Dentofacial Orthop 2004. Lione R. Sameshima GT. Lione R. 38. Ludlow JB. Accuracy of cone beam computed tomography for periodontal defect measurements. Ahlqvist J. Karoglan A.91:3-14. Garib DG.128:418-23. Lagravre MO. Skeletal and dental changes after maxil¸ lary expansion in the mixed dentition.8: 141-8. Baccetti T. Modder U. 36. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008. Ivanovic M.e1-11. Podesser B. Enciso R. September 2011  Vol 140  Issue 3 American Journal of Orthodontics and Dentofacial Orthopedics . Pawelzik J. 27. Kan JYK. Rungcharassaeng K.376 Weissheimer et al 15. Cozza P. 29. Fernandes AY. Eur J Orthod 1988. Aboudara CL. Cleft Palate Craniofac J 2005. Sandikciolu M.79:24-9. Am J Orthod Dentofacial Orthop 2004. The effect of projection errors on cephalometric length measurements. Freitas MR. Noguchi K. Taylor GD. 32. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Carano A.134:8.e1-8. Sarment DP. Caruso JM.126:354-62. Incorvati C. A new x-ray technique and its application to orthodontia. Farrage JR. Bishara SE. Garrett BJ. Am J Orthod Dentofacial Orthop 2007. Henriques JF. Oliveira NL. Am J Orthod Dentofacial Orthop 1997. Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. Cozza P. Eur J Orthod 2007. Eur J Orthod 1986. Arai Y. Kim JS. Rungcharassaeng K. Three-dimensional localization of maxillary canines with cone-beam computed tomography. Eur Radiol 2002. Sommer B. Am J Orthod Dentofacial Orthop 2008. Janson G.118:257-61.and three-dimensional orthodontic imaging using limited cone beam-computed tomography. Factors affecting buccal bone changes of maxillary posterior teeth after rapid maxillary expansion. Angle Orthod 1931. Am J Orthod Dentofacial Orthop 2008. 35. Hatcher DC. Taylor G. 33. Kusnoto B.106:106-14.75:548-57. Franchi L. tomography evaluation. Habersack K.131:776-81. 25.132:428. Janson G. Bottrel JA. Fanucci E. de Freitas MR. Da Silveira AC. Hamada Y. Flores-Mir C. Am J Orthod Dentofacial Orthop 2000. Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: a computed 28. J Periodontol 2006. Treatment and posttreatment skeletal effects of rapid maxillary expansion studied with low-dose computed tomography in growing subjects. Henriques JFC. Bantleon HP.