2 anya A, Maeshwan S., Gupta NO, Goyal, Maxillary expansion - an interceptive modality in mixed dentition Dahiya A. ¢, Maheshwari S. ®, Gupta N.D. © Goyal S, ¢, Rohtak, GOVT. DENTAL GOLLEGE, PT. B.D. SHARMA PGIMS. ‘Maxilary expansion is a very useful procedure for arch length augmentation, posterior crossbite treatment and removing cross arch interferences. Removable appliances are in the realm of a pedodontist and general dentist. However, one should be aware of the problems arising at an early age of the child, should be able to properly diagnose the condition and if required, 2 tmaly referral to a specialists also expected. (J Indian Soc Pedo Prev Dent 1999; 18:1:24-28) Key words: Expansion, Early treatment, Mixed dentition. Eeary consideration of to corestve measures nocassary to remedy any type of malocclusion should be the prime concern of moder orthodontics. Tweed termed mixed dentition treatment as ‘preorthodontic guidance,” which means treatment at an early stage before the eruption of all bicuspid teeth but without full banded corrective orthodontios.* Arch length-tooth size discrepancy in mixed dentition can be corrected by leeway space maintenance and its utilization, arch expansion of serial extraction, Expansion, particularly in the mixed dentition (in growing patients) for arch length augmentation can be either ‘orthodontic expansion or orthopaedic expansion, which may be slow or rapid according to rate of expansion. Siow expansion of arches using a removable appliance with an incorporated expansion screw gives stable results Mition. Skieller? used a similar appliance n. The expansion screw was opened at the rate of 0.5 mm/week for 7 months and then maintained for 12 months. The results showed thet both the dental arenes and palatal vault expanded and the results were ‘more stable for the 9 year age group as compared to the Ex. PG. Student, Department of Orthodontics Reader and Head, Department of Orthodontics 1, Department of Periodontics Demonstrator, Department of Orthodontics. Reader and 12 year age group. Studies have** shown that slower rates of expansion allow for physiologic adjustments at the maxillary articulation and prevent the accumulation of large residual loads which causes relapse alter rapid ‘maxillary expansion (RME). It Is imperative that some of the patients treated with early expansion might have to undergo a second phase of fixed orthodontic therapy, but the results of early expansion are skeletal, more stable and physiologic coordinating with favourable growth of the facial complex. This anticte gives a layout plan for diagnosis and treatment planning with special reference to active removable ‘expansion appliance in young children in the mixed dentition stage and advantages of the same. MECHANICS Pierre Robin (1902) constructed the first split appliance with an incorporated screw. In England, JH. Badcock (1911) described an expansion appliance. For the next three decades E.H. Angle's fixed appliances dominated the scene. A.M. Schwarz reintroduced active plates with different screws and springs incorporated in it. Removable plates with expansion screws are most commonly used for expansion of arches in the transverse andfor anteroposterior direction. The activation of this appliance involves opening the screw at 90° and driving the 2 parts apart by 0.25 mm, producing forces ranging from 3 to 10 pounds. This compresses the teeth in the socket by 0.12 mm per side which is within the width of periodontal ligament (0.25mm). Such a mild reduction of periodontal space would not interrupt the blood circulation and thus creates ideal conditions for tooth movement and bone transtormation. The force dissipates to the midpalatal suture and augments the normal expansive process at the suture. This action is achieved only in growing in dividuals till 10-11 years of age. Once the suture has calcified, more force is required for suture disruption which can be harmful to dentoalveotar structures,‘indian Soe Pedo Prev Dent March 2000 The frequency of opening of the screw is dependent on the pitch of screw (Imm), age of patient, type and range of correction required. Usually the screw is opened at 90° (1/4 tun) every 2-3 days for 56-84 days in the ‘mixed dentition. Then for 3-4 months, the same appliance 4s used as a retention appliance and allows the coordination ‘and functional expansion of mandibular arch. If required, after that a second phase of active expansion is continued. The space which becomes available? after expansion of ‘mm across canines is 1mm increase in arch length, ‘Imm across bicuspids increases 1/2 mm arch length and ‘Imm across molars increases 1/3 mm arch length. In a simpler way, 1mm expansion with bonded appliance ‘gives 1.57 mm of space to correct tooth size-arch length discrepancy®, Indications and advantages of expansion in mixed dentition: 1. Maxillary andjor mandibular constriction with proctination or crowding: The earty arch expansion to correct mild crowding/prociination offers certain advantages: + Early alignment of maxillary anterior teeth before ‘maturation of their transseptal fibre system has proved be more stable with no root resorption = Improved esthetics and less psychological trauma + Protection of excessively prociined teeth against accidental harms. + Better eruptive path of malposed tooth. 2. Anterior/posterior crossbite: Crossbite causes a contained maxillary arch resulting in restricted ‘maxillary growth or a deflective mandibular closure, resulting in pseudo-class II! malocclusion or ‘asymmetric face, Early correction assures normal growth of facial comple: Distocclusion in mixed dentition: Which could be because of a constricted maxilla and locked mandible. This causes altered and deficient mandibular growth. Maxillary expansion can cause favourable and enhanced mandibular growth and improves patient's self image. 4 Angle's Class I div. 2 malocclusion: With retroclined anterior teeth causes restricted mandibular growth or posterior posturing of ‘mandible leading to skeletal problems. Alignment with expansion causes a normal growth and correction of molar relation by Itself, by releasing “mandibular entrapment”. ‘Temporomandibular dystunction: resulting from constricted maxillary arch can be improved with expansion and a bite plate. It helps to remove the ‘cross arch interferences and thus helping to attain a normal path of closure. 6. Nasal insufficiency: because of high and narrow palate and maxillary constriction. It can be improved with early expansion, as expansion helps to widen the nasal passage and normal descent of palate. The advantages of early treatment are added up as-post treatment stability, less requirement for extractions during future treatment and improved oral health because of reducing the possibility of periodontal damage due to malocclusion. Also, treatment of patients in preadolescent phase gives good results and treatment becomes easier, cheaper and less time-consuming CASE REPORTS Case A: A girl of 8 years reported with the problem of labially placed right central incisor. There was a posterior land anterior crossbite with space discrepancy in upper arch as 3 mm. Transverse expansion for 8 months followed with Hawley retainer for 3 months resulted in alignment of labially placed incisor as space was made available for that tooth (Fig. 1.4). Case B: A10 year-old male patient with anterior crossbite with concave profile. Appliance for antero-posterior ‘expansion and with posterior bite plane was given for 6 ‘months to correct crossbite. The post-treatment photograph shows change in facial profile towards straight and normal anterior teeth relationship (Fig. 5-8), Case C: Agirl of 10 years with developing class Il division 1 malocclusion in mixed dentition and space discrepancy ‘of 4mm in upper arch was given upper expansion appliance for 6 months. Transverse expansion of upper arch resulted in retraction of anterior teeth with improved profile as well as mandibular advancement with molar correction (Fig. 9-12), DISCUSSION Expansion in the mixed dentition is very advantageous as it can correct developing malocclusion and produce favourable growth changes. Hence, this procedure canDahiya A, Mebortwan S., Gupta ND. Goyel S{Indian Soe Paco Prav Dent March 2000 2 Fig. 8: Exra-orl profile view showing normal proto (posttreatment) Fig. 9: Intra-oral frontal view snowing increases overiet Fig. 10 : Extr-oral praia view showing convex facial protile and (pretreatment) manclbiar retrognathin (pretreatment) Fig. 14: Intra-oral Wontal view showing normal ovexet and ove! Fg. 12 : Extra-ral profile wew showng well balanced facil protle bite (posttreatment) (posttreatment)2 Dahiya A, Maboshwar S., Gupta ND, Goyl 8 ‘be included among the routine pedodontic care or general dentistry procedures. Careful differential diagnosis and ‘treatment planning should be done, as it involves the ‘growing child. It Is also Imperative that some of these patients might have to undergo a second phase of orthodontic therapy. REFERENCES. 1. Wagers LE. Praorthodontc guidance and the corectve mixed dentition concept. Am J Orthod 1978; 68: 128. 2, Skiollor V, Expansion of the midpalatal suture by removable plates onalysed by the Implant method. Trans Eur Orthos Soc 1984; 143-158 3, Ianacson Al. Ingram AM. Foroes produced by rapld maxilary ‘expansion I, Forces present during treatment. Angle Orthod 1964; 24:281-70. 4, Zimring JF, Isaacson RJ. Forces produced by rapid mexliry ‘expansion Ill, Forces present during retention. Angla Orthod 1068: 35: 178-86 5. Hicks EP, Slow maxilary expansion. A clinical study of the skeletal versus dental response to low magnitude force, Am J Orthod 1978; 73: 121-44 LM, Maxillary expansion: clinical Implications. Am J Orthod Dentotae Orthop 1987; 91: 3-14, 7. Rlokatts A.M, ot al. Bloprogressive therapy. Denver 1979; Rocky Mountain Orthodontics. 8," Hamiton D.C. Early growin madiication: The elimination of Patient co-operation: Symposium at World Congress and 31st Ingian Orthodontics 1987, 9. Fields H.W. Treatment of non skeletal problems in Preadolescent children. In Prottit W.R, Contemporary ‘Orthodontics, 2nd ed. Mosby year Book, St. Lovis, 1993. 10. Graber TM. Vanaredall R.L. Orthodontiee: Current principles tnd technique, St. Louls Mosby Year Book 1965. Roprint roqu Dr. Sangnya Mat leader and Head, Department of Orthodontics, Govt, Dental College, Pt. 8.0. Sharma PGIMS, ‘lohtak-124001 (Haryana)