Professional Documents
Culture Documents
American Journal of Orthodontics and Dentofacial Orthopedics April 2016 Vol 149 Issue 4
446 Readers' forum
mentioning the status of the midpalatal suture would the authors to share the changes in transverse skeletal
have been beneficial in justifying the treatment plan dimensions, if any. Although the authors reported taking
chosen. It is not clear in the methodology whether any a posttreatment computed tomography scan for evalu-
orthopedic separation at the midpalatal suture was ating buccal bone thickness, they did not comment on
desired. Since this approach is being advocated as an the transverse skeletal changes in the maxilla and the
alternative to surgically assisted rapid palatal expansion, status of the midpalatal suture.
which aims to achieve expansion by separating the 2 Raising a full-thickness mucoperiosteal flap leads to
halves of the maxilla at the midpalatal suture, the nature bone loss2,3; hence, in most procedures involving a
of the expansion expected with a corticotomy-assisted full-thickness mucoperiosteal flap, bone grafting is
RME should also be commented upon. Was the cortico- done. How did the authors justify an increase in bone
tomy on the buccal cortical plate done only to induce an mass without an adjunctive bone graft in the region?
inflammatory response, or was it desired to help in the Since the results of this case report are very prom-
expansion of the maxillary arch? Was the corticotomy ising, we would appreciate it if the authors could share
done only in the single (buccal) cortical plate sufficient their views.
to circumvent the resistance from the midpalatal suture? Priyank Rai
No justification has been mentioned. Tulika Tripathi
In this case report, the expansion was said to be RME; Shilpa Kalra
however, the expansion schedule followed was 1 mm per Anup Kanase
week for 8 weeks after the corticotomy. The schedule Neha Khanna
advocated for RME is typically 0.5 to 1 mm of expansion Navneet Singh
per day in routine practice. So how did the authors New Delhi, India
justify calling their approach RME? Also, it is docu-
Am J Orthod Dentofacial Orthop 2016;149:445-6
mented in the literature that the maximum inflamma- 0889-5406/$36.00
tory response to the regional accelerated phenomenon Copyright Ó 2016 by the American Association of Orthodontists.
is within the first few weeks after the procedure.1 What http://dx.doi.org/10.1016/j.ajodo.2016.01.006
was the rationale behind not following the routine
RME protocol of 0.5 to 1 mm per day that would have REFERENCES
further reduced the duration of treatment? 1. Wilcko MT, Wilcko WM, Bissada NF. An evidence-based analysis of
Changes in the inclination of the maxillary posterior periodontally accelerated orthodontic and osteogenic techniques: a
teeth (Table IV of the article) indicate dental expansion synthesis of scientific perspectives. Semin Orthod 2014;14:305–16.
with palatal inclination of the maxillary posterior teeth. 2. Wood DZ, Hoag PM, Donnenfield OW, Rosenfield LD. Alveolar crest
reduction following full and partial thickness flaps. J Periodontol
Another question that arose was whether only dental
1972;43:141–4.
expansion was sufficient to resolve an arch length 3. Fickl S, Kebschull M, Schupbach P, Zuhr O, Schlagenhauf U,
discrepancy of 17 mm in the maxillary arch or whether Hurzeler MB. Bone loss after full-thickness and partial-thickness
some skeletal expansion was achieved. We would like flap elevation. J Clin Periodontol 2011;38:157–62.
April 2016 Vol 149 Issue 4 American Journal of Orthodontics and Dentofacial Orthopedics