Seminars in Orthodontics
VOL 25, NO 1
Introduction
T his issue of Seminars in Orthodontics is
devoted to the diagnosis and treatment
planning of malocclusions in the transverse
dimension. The definition of “adequate trans-
verse relationship” will be redefined and the
issue will focus on identifying maxillary trans-
verse deficiencies in patients with and without
posterior crossbites. Diagnosis in the transverse
dimension should be on the top of our problem
list when we formulate a treatment plan for our
patients. The presence of facial asymmetry, ante-
roposterior jaw differences, insufficient buccal
overjet and compensation in the posterior area
can all contribute to a relative or absolute maxil-
lary transverse deficiency. Treatment of trans-
verse problems in the primary or early mixed
dentition can still utilize conventional tooth-
borne rapid maxillary expansion appliance.
However, adolescent patient with more mature
skeletal development may require bone-borne
anchorage for maxillary expansion. The gold
standard for treatment of transverse deficiencies
in adults is still the use of Surgical Assistant Rapid
Palatal Expansion (SARPE) appliance. With the
advent of Temporary Skeletal Anchorage Device
(TSAD), the envelope of non-surgical treatment
of maxillary transverse deficiencies can be
increased to include the young adults. In this
issue, the authors will update our readers from
the diagnosis of transverse deficiency to the sta-
bility of treatment with maxillary expansion
devices.
First, Dr. McNamara and his colleagues sum-
marized the results of a series of clinical studies
beginning in the late 1970s at the University of
Michigan on the etiology of dental crowding as
well as treatment effects produced by expansion
in the late mixed/early permanent dentition
and the early mixed dentition. The authors
also presented evidence on the spontaneous
© 2019 Elsevier Inc. All rights reserved.
https://doi.org/10.1053/j.sodo.2019.02.001
Seminars in Orthodontics, Vol 25, No 1, 2019: pp 1 2
MARCH 2019
improvement of Class II malocclusion following
increases in the transverse dimension and the
effect of maintaining or increasing anterior arch
length on subsequent mandibular second molar
eruption.
Maxillary and mandibular skeletal widths and
buccolingual inclination of posterior teeth has
been traditionally evaluated by using posteroan-
terior (PA) cephalogram and dental casts. How-
ever, it is difficult to identify landmarks on these
radiographs due to the superimposed structures
on the PA cephalograms. In addition, dental
casts can neither reveal skeletal dimensions of
the two jaws, nor the root positions in the alveo-
lar bone. Dr. Chung introduces a CBCT analysis
to assess the maxillary and mandibular skeletal
widths at different tooth levels, buccolingual
inclination of each tooth, and their root posi-
tions in the alveolar bone for proper transverse
evaluation.
The acquisition of a CBCT scan for patients
with maxillary deficiencies allows clinicians to
evaluate the root position in alveolar bone.
Dr. Glass and his colleagues reported on whether
the mandibular posterior teeth are more centered
over basal bone, or if the estimated center of resis-
tance of mandibular posterior teeth is most often
centered in alveolar bone.
Young patients with transverse maxillary defi-
ciencies are often present with a unilateral poste-
rior crossbite and a functional side shift. Do
these functional shifts cause positional change of
the condyles in the fossa? Dr. Pittman and his col-
leagues presented data to determine if pathologi-
cal position of the condyles cause condylar signs
or symptoms like degenerative joint disease
(DJD) or juvenile condylar resorption (JCR), or
if the position of the condyle is just an altered
position within the TMJ.
Recent studies have focused on using Micro-
implant Assisted Rapid Maxillary Expansion
(MARPE) appliances to separate mid-palatal
sutures. Dr. He and her colleagues evaluated the
1
2 Ngan
immediate skeletal and dentoalveolar changes
with one type of MARPE appliances—the Maxil-
lary Skeletal Expander (MSE) using CBCT scans.
This type of MARPE appliance is unique in a
sense that the micro-implants actually penetrate
two layers of cortical bone in the palate to
achieve greater orthopedic changes. If so, why is
it still necessary to anchor on the maxillary poste-
rior teeth to make it a hybrid bone-borne and
tooth-borne appliance?
For those of you who are interested in the skel-
etal and dental changes of three different types
of expanders— a traditional tooth-anchored
maxillary expander (TAME) and two different
types of MARPE, bone-anchored maxillary
expander (BAME) and tooth-bone-anchored
expander (MSE), Dr. Oh and her colleagues
documented changes before and after treatment
with these appliances using CBCT scans. This is
particularly helpful for clinicians who are starting
to either use bone-borne anchorage device or
learn about the advantages of using bone-borne
anchorage device to increase the scope of ortho-
pedic treatment in adolescent patients.
Finally, Dr. Southard and his colleagues
updated clinicians on the diagnosis and treatment
planning for adults with maxillary transverse defi-
ciency. How do we detect maxillary transverse defi-
ciency in adults if there is absence of a posterior
crossbite? How do we differentiate between skele-
tal and dental problems? How do we choose
between using Surgical Assistant Rapid Maxillary
Expansion (SARME) and Multiple Piece Maxillary
Osteotomy (MPMO) for treatment of skeletal
maxillary transverse problems? When would the
ideal time be to remove mandibular transverse
compensations? Do you know how to achieve a
true unilateral SARME expansion?
Peter W. Ngan
Guest editor
E-mail: pngan@hsc.wvu.edu