Analysis of the distribution of maxillary stresses submitted to surgically assisted rapid maxillary expansion with a bone-supported device

Authors

DOI:

https://doi.org/10.33448/rsd-v11i2.25845

Keywords:

Palatal Expansion Technique; Finite Element Analysis; Dental stress analysis.

Abstract

The objective of the research was to evaluate the distribution of stress produced by surgically assisted rapid maxillary expansion in the maxillary structures using the bone-supported expander device by the Finite Element Method. Material and methods: A three- dimensional model was simulated for surgery with a LeFort I osteotomy with pterygomaxillary disjunction using a bone-supported device model for the 1mm aperture. The results showed a greater opening of the maxilla in the anterior region and a smaller opening in the posterior region. The tension forces showed mainly in all the palatine face and the posterior alveolar bone and tuber, as well as in the epilating zygomatic region above the osteotomy. The stress showed little dissipation for the roots of the molar. The forces of compression were manifested in the pterygoid process and the zygomatic pillar adjacent to the osteotomies, as well as in the expander areas of contact with the palatine bone. The analysis showed that the most stressed part is the rod connecting the device module to the support platform. Conclusion: The resulting tension stresses transmitted to the alveolar bone of the teeth adjacent to the appliance did not seem to be sufficient to displace the teeth.

References

Asscherickx, K., Govaerts, E., Aerts, J., & Vande Vannet, B. (2016). Maxillary changes with bone-borne surgically assisted rapid palatal expansion: A prospective study. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 149(3), 374–383. https://doi.org/10.1016/j.ajodo.2015.08.018

Aziz, S. R., & Tanchyk, A. (2008). Surgically assisted palatal expansion with a bone-borne self-retaining palatal expander. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 66(9), 1788–1793. https://doi.org/10.1016/j.joms.2008.04.017

Babacan, H., Sokucu, O., Doruk, C., & Ay, S. (2006). Rapid maxillary expansion and surgically assisted rapid maxillary expansion effects on nasal volume. The Angle orthodontist, 76(1), 66–71. https://doi.org/10.1043/0003-3219(2006)076[0066:RMEASA]2.0.CO;2

Basdra, E. K., Zöller, J. E., & Komposch, G. (1995). Surgically assisted rapid palatal expansion. Journal of clinical orthodontics : JCO, 29(12), 762–766

Bays, R. A., & Greco, J. M. (1992). Surgically assisted rapid palatal expansion: an outpatient technique with long-term stability. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 50(2), 110–115. https://doi.org/10.1016/0278-2391(92)90352-z

Bell, W. H., & Epker, B. N. (1976). Surgical-orthodontic expansion of the maxilla. American journal of orthodontics, 70(5), 517–528. https://doi.org/10.1016/0002-9416(76)90276-1

Bishara, S. E., & Staley, R. N. (1987). Maxillary expansion: clinical implications. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 91(1), 3–14. https://doi.org/10.1016/0889-5406(87)90202-2

Boryor, A., Hohmann, A., Wunderlich, A., Geiger, M., Kilic, F., Sander, M., Sander, C., Böckers, T., & Günter Sander, F. (2010). In-vitro results of rapid maxillary expansion on adults compared with finite element simulations. Journal of biomechanics, 43(7), 1237–1242. https://doi.org/10.1016/j.jbiomech.2010.02.002

Carneiro, J. T., Jr, Paschoal, E. H., Carreira, A. S., & Real, R. P. (2013). Carotid cavernous fistula after surgically assisted rapid maxillary expansion with a bone anchored appliance. International journal of oral and maxillofacial surgery, 42(3), 326–328. https://doi.org/10.1016/j.ijom.2012.10.00

Chung, C. H., & Goldman, A. M. (2003). Dental tipping and rotation immediately after surgically assisted rapid palatal expansion. European journal of orthodontics, 25(4), 353–358. https://doi.org/10.1093/ejo/25.4.353

Assis, D. S., Ribeiro, P. D., Jr, Duarte, M. A., & Gonçales, E. S. (2011). Evaluation of the mesio-buccal gingival sulcus depth of the upper central incisors in patients submitted to surgically assisted maxillary expansion. Oral and maxillofacial surgery, 15(2), 79–84. https://doi.org/10.1007/s10006-010-0233-x

Assis, D. S., Xavier, T. A., Noritomi, P. Y., & Gonçales, E. S. (2014). Finite element analysis of bone stress after SARPE. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 72(1), 167.e1–167.e1677. https://doi.org/10.1016/j.joms.2013.06.210

Assis, D. S., Xavier, T. A., Noritomi, P. Y., Gonçales, A. G., Ferreira, O., Jr, de Carvalho, P. C., & Gonçales, E. S. (2013). Finite element analysis of stress distribution in anchor teeth in surgically assisted rapid palatal expansion. International journal of oral and maxillofacial surgery, 42(9), 1093–1099. https://doi.org/10.1016/j.ijom.2013.03.024

Gijt, J. P., Gül, A., Tjoa, S. T., Wolvius, E. B., van der Wal, K. G., & Koudstaal, M. J. (2017). Follow up of surgically-assisted rapid maxillary expansion after 6.5 years: skeletal and dental effects. The British journal of oral & maxillofacial surgery, 55(1), 56–60. https://doi.org/10.1016/j.bjoms.2016.09.002

Gauthier, C., Voyer, R., Paquette, M., Rompré, P., & Papadakis, A. (2011). Periodontal effects of surgically assisted rapid palatal expansion evaluated clinically and with cone-beam computerized tomography: 6-month preliminary results. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 139(4 Suppl), S117–S128. https://doi.org/10.1016/j.ajodo.2010.06.022

Gerlach, K. L., & Zahl, C. (2005). Surgically assisted rapid palatal expansion using a new distraction device: report of a case with an epimucosal fixation. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 63(5), 711–713. https://doi.org/10.1016/j.joms.2004.12.017

Gonçales ES, Assis DSFR, Capelozza ALA, Alvares LC. (2007). Estudo radiográfico digital indireto do efeito da expansão de maxila cirurgicamente assistida (EMCA) sobre o septo nasal. R Dental Press Ortodon Ortop Facial.; 12(5):85-91. https://doi.org/10.1590/S1415-54192007000500011

Gonçales ES. (2011). Análise da distribuição das tensões dentárias em maxila submetida a expansão cirurgicamente assistida [Livre Docência]. Faculdade de Odontologia de Bauru – USP. https://doi.org/10.11606/T.25.2012.tde-13032012-092604

Haas, A.J. (1961) Rapid expansion of the maxillary dental arch and nasal cavity by opening of the midpalatal suture. The Angle Orthodontics, 31, 73-90

Holzinger, D., Carvalho, P., Dos Santos, J. C., Wagner, F., Gabrielli, M., Gabrielli, M., & Filho, V. (2021). Bone formation after surgically assisted rapid maxillary expansion: comparison of 2 distraction osteogenesis protocols. Oral surgery, oral medicine, oral pathology and oral radiology, S2212-4403(21)00488-0. Advance online publication. https://doi.org/10.1016/j.oooo.2021.06.013

Jafari, A., Shetty, K. S., & Kumar, M. (2003). Study of stress distribution and displacement of various craniofacial structures following application of transverse orthopedic forces--a three-dimensional FEM study. The Angle orthodontist, 73(1), 12–20. https://doi.org/10.1043/0003-3219(2003)073<0012:SOSDAD>2.0.CO;2

Kilic, E., Kilic, B., Kurt, G., Sakin, C., & Alkan, A. (2013). Effects of surgically assisted rapid palatal expansion with and without pterygomaxillary disjunction on dental and skeletal structures: a retrospective review. Oral surgery, oral medicine, oral pathology and oral radiology, 115(2), 167–174. https://doi.org/10.1016/j.oooo.2012.02.026

Koudstaal, M. J., van der Wal, K. G., Wolvius, E. B., & Schulten, A. J. (2006). The Rotterdam Palatal Distractor: introduction of the new bone-borne device and report of the pilot study. International journal of oral and maxillofacial surgery, 35(1), 31–35. https://doi.org/10.1016/j.ijom.2005.07.002

Koudstaal, M. J., Wolvius, E. B., Schulten, A. J., Hop, W. C., & van der Wal, K. G. (2009). Stability, tipping and relapse of bone-borne versus tooth-borne surgically assisted rapid maxillary expansion; a prospective randomized patient trial. International journal of oral and maxillofacial surgery, 38(4), 308–315. https://doi.org/10.1016/j.ijom.2009.02.012

Lanigan, D. T., & Mintz, S. M. (2002). Complications of surgically assisted rapid palatal expansion: review of the literature and report of a case. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 60(1), 104–110. https://doi.org/10.1053/joms.2002.29087

Lee, S. C., Park, J. H., Bayome, M., Kim, K. B., Araujo, E. A., & Kook, Y. A. (2014). Effect of bone-borne rapid maxillary expanders with and without surgical assistance on the craniofacial structures using finite element analysis. American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 145(5), 638–648. https://doi.org/10.1016/j.ajodo.2013.12.029

Möhlhenrich, S. C., Ernst, K., Peters, F., Kniha, K., Chhatwani, S., Prescher, A., Danesh, G., Hölzle, F., & Modabber, A. (2021). Immediate dental and skeletal influence of distractor position on surgically assisted rapid palatal expansion with or without pterygomaxillary disjunction. International journal of oral and maxillofacial surgery, 50(5), 649–656. https://doi.org/10.1016/j.ijom.2020.10.003

Ramieri, G. A., Spada, M. C., Austa, M., Bianchi, S. D., & Berrone, S. (2005). Transverse maxillary distraction with a bone-anchored appliance: dento-periodontal effects and clinical and radiological results. International journal of oral and maxillofacial surgery, 34(4), 357–363. https://doi.org/10.1016/j.ijom.2004.10.011

Schwarz, G. M., Thrash, W. J., Byrd, D. L., & Jacobs, J. D. (1985). Tomographic assessment of nasal septal changes following surgical-orthodontic rapid maxillary expansion. American journal of orthodontics, 87(1), 39–45. https://doi.org/10.1016/0002-9416(85)90172-1

Seeberger, R., Kater, W., Davids, R., & Thiele, O. C. (2010). Long term effects of surgically assisted rapid maxillary expansion without performing osteotomy of the pterygoid plates. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 38(3), 175–178. https://doi.org/10.1016/j.jcms.2009.07.003

Shetty, P., Hegde, A. M., & Rai, K. (2009). Study of stress distribution and displacement of the maxillary complex following application of forces using jackscrew and nitanium palatal expander 2--a finite element study. The Journal of clinical pediatric dentistry, 34(1), 87–93. https://doi.org/10.17796/jcpd.34.1.dv5100j371184087

Shetty, V., Caridad, J. M., Caputo, A. A., & Chaconas, S. J. (1994). Biomechanical rationale for surgical-orthodontic expansion of the adult maxilla. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 52(7), 742–751. https://doi.org/10.1016/0278-2391(94)90492-8

Verstraaten, J., Kuijpers-Jagtman, A. M., Mommaerts, M. Y., Bergé, S. J., Nada, R. M., Schols, J. G., & Eurocran Distraction Osteogenesis Group (2010). A systematic review of the effects of bone-borne surgical assisted rapid maxillary expansion. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 38(3), 166–174. https://doi.org/10.1016/j.jcms.2009.06.006

Williams, B. J., Currimbhoy, S., Silva, A., & O'Ryan, F. S. (2012). Complications following surgically assisted rapid palatal expansion: a retrospective cohort study. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 70(10), 2394–2402. https://doi.org/10.1016/j.joms.2011.09.050

Zandi, M., Miresmaeili, A., Heidari, A., & Lamei, A. (2016). The necessity of pterygomaxillary disjunction in surgically assisted rapid maxillary expansion: A short-term, double-blind, historical controlled clinical trial. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery, 44(9), 1181–1186. https://doi.org/10.1016/j.jcms.2016.04.026

Downloads

Published

03/02/2022

How to Cite

TIEGHI NETO, V.; BARBOSA, C. G. .; SANCHES, I. M. .; NORITOMI, P. Y. .; SILVA, J. V. L. da .; GONÇALES, E. S. . Analysis of the distribution of maxillary stresses submitted to surgically assisted rapid maxillary expansion with a bone-supported device. Research, Society and Development, [S. l.], v. 11, n. 2, p. e49811225845, 2022. DOI: 10.33448/rsd-v11i2.25845. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/25845. Acesso em: 19 apr. 2024.

Issue

Section

Health Sciences