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3d Effect Pterigo Sarme PDF
3d Effect Pterigo Sarme PDF
6 June 2016
602
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Volume 121, Number 6
ORIGINAL ARTICLE
Mhlhenrich et al. 603
Fig. 1. Detachment of the pillars of the maxilla with osteotomies between the piriform apertures, through the zygomatic
buttress, to the maxillopterygoid junction, the nasal septum,
and lateral to the midpalatal suture, and without pterygomaxillary disconnection (group 1).
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Fig. 2. Situation models before (left) and after rapid maxillary expansions with the rapid palatal expander (RPE) about 10 turns/10
mm without (middle) and with pterygomaxillary disconnection (right).
RESULTS
The mean linear distances between the regions of the
maxillary incisors as well as between the regions of the
second premolars before and after SARPE with and
DISCUSSION
Different locations of bony resistance to maxillary
expansion have been described in the context of
SARPE, which include the anterior piriform aperture
pillars, lateral zygomatic buttresses, posterior pterygoid
junctions, and medial midpalatal synostosed sutures.4
Although SARPE is a well-established technique for
the correction of transverse maxillary discrepancies,
there is no consensus on the ideal surgical technique
and the type of distraction device (tooth-borne or boneborne) because of the inadequate evidence on the corresponding skeletal effects.17 Betts and Ziccaridi
observed weakening of the anterior, lateral, posterior,
and median supports of the maxillary arch by a total
bilateral maxillary osteotomy, from the piriform
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Volume 121, Number 6
ORIGINAL ARTICLE
Mhlhenrich et al. 605
Fig. 3. Software based comparison of the virtual models before and after surgery with pterygomaxillary disconnection using an
iterative closest point algorithm.
Table I. Mean linear distances between the regions of the maxillary incisors and the regions of the second premolars
before and after surgically assisted rapid palatal expansion (SARPE) with and without pterygomaxillary disconnection
Regionedistances (mm)
After SARPE
Before SARPE
Cadaver
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Mean
SD
Incisor
Second premolar
Incisor
Second premolar
Incisor
Second premolar
4.51
1.32
1.19
2.52
1.11
2.16
1.04
0.00
1.79
1.01
0.09
1.78
0.00
1.88
1.60
1.47
1.14
40.51
46.53
46.46
51.23
48.53
46.51
41.19
49.11
44.49
49.29
49.09
44.01
48.18
44.05
47.55
46.45
3.07
9.63
7.76
6.31
7.62
6.29
6.60
4.91
6.97
6.18
7.88
7.33
6.32
6.19
7.84
5.44
6.88
1.17
42.12
50.49
47.51
53.42
50.23
52.53
43.21
51.58
44.53
53.55
51.23
46.32
53.64
46.87
48.92
49.08
3.82
7.43
6.31
5.56
5.79
5.92
4.55
4.91
6.78
6.21
5.34
4.43
4.91
4.62
5.88
4.11
5.52
0.94
44.51
53.30
49.49
54.23
52.34
53.53
43.27
53.49
44.54
54.81
53.86
46.31
55.56
48.22
50.32
50.52
4.19
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Table II. Mean differences in maximum deviation between virtual models after both surgically assisted rapid palatal
expansion (SARPE) techniques
Deviation after SARPE (mm)
Without pterygomaxillary disconnection
Cadaver
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Mean
SD
Incisor
Second premolar
Palate right
Palate left
Incisor
Second premolar
Palate right
Palate left
5.12
6.44
5.12
5.1
5.18
4.44
3.87
6.97
4.39
6.87
7.24
4.54
6.19
5.96
3.84
5.42
1.13
1.61
3.96
1.05
2.19
1.7
6.02
2.02
2.47
0.04
4.26
2.14
2.31
5.46
2.82
1.37
2.63
1.64
0.24
0.67
0.27
0.42
0.34
0.8
0.43
0.41
0.01
0.74
0.41
0.52
0.73
0.6
0.32
0.46
0.22
0.5
1.34
0.53
0.83
0.68
1.6
0.86
0.81
0.01
1.51
0.81
1.04
1.46
1.18
0.63
0.92
0.19
2.92
4.99
4.37
3.27
4.81
2.39
3.85
6.78
4.42
4.33
4.34
3.13
4.62
4
2.51
4.05
1.12
4
6.77
3.03
3
3.81
7.02
2.14
4.38
0.05
5.52
4.77
2.3
7.38
4.17
2.77
4.07
2.01
0.28
0.66
0.25
0.45
0.33
0.82
0.41
0.45
0.06
0.76
0.44
0.49
0.77
0.55
0.29
0.47
0.22
0.52
1.32
0.49
0.89
0.66
1.64
0.81
0.89
0.12
1.46
0.87
0.98
1.53
1.12
0.58
0.93
0.43
Fig. 4. Boxplot of the comparisons between the deviations after surgically assisted rapid palatal expansion (SARPE) with and
without pterygomaxillary disconnection.
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Volume 121, Number 6
ORIGINAL ARTICLE
Mhlhenrich et al. 607
CONCLUSIONS
In spite of the limitations of this study, we conclude that
SARPE is an effective method to achieve transverse
maxillary expansion. SARPE performed without
osteotomy of the pterygoid plates leads to a V-shaped
transverse expansion, whereas SARPE with pterygomaxillary disconnection shows a parallel transverse
maxillary expansion in the anterior and posterior segments of the maxilla. However, mechanical transverse
expansion does not match clinical expansion, possibly
because of bony resistance.
REFERENCES
1. Angell EC. Treatment of irregularities of the permanent adult
teeth. Dent Cosmos. 1860;1:540-545.
2. Haas AJ. Palatal expansion: just the beginning of dentofacial
orthopedics. Am J Orthod. 1970;57:219-255.
3. Haas AJ. Long-term posttreatment evaluation of rapid palatal
expansion. Angle Orthod. 1980;50:189-217.
4. Suri L, Taneja P. Surgically assisted rapid palatal expansion: a
literature review. Am J Orthod Dentofacial Orthop. 2008;133:
290-302.
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Reprint requests:
Stephan Christian Mhlhenrich, DMD, MSc
Department of Orthodontics
RWTH Aachen University Hospital, Pauwelsstrae 30
52074 Aachen, Germany
Smoehlhenrich@ukaachen.de