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Objectives: To assess skeletal and dental effects and evaluate possible side effects of maxillary expansion with two different appliances, directly after expansion and 1 year postexpansion. Materials and Methods: Forty-two patients with unilateral posterior crossbite (mean 9.5 +/- 0.9 years) were randomized to either rapid maxillary expansion (RME) banded on the deciduous second molars and bonded to the primary canines or slow expansion with quad helix (QH) on the permanent first molars. Cone-beam computed tomography records were taken at baseline, directly after correction of the posterior crossbite and at follow-up 1 year after expansion. Results: All patients were analyzed. RME opened the midpalatal suture more anteriorly and inferiorly (mean 4.1 mm) and less posteriorly and superiorly (mean 1.0 mm). No effect on midpalatal suture could be shown in the QH group after expansion, P < .001. Buccal bone width had significantly decreased (P < .001) in the QH group compared with the RME group. Buccal fenestrations and root resorption on the left first molar had a higher prevalence directly after expansion finished in the QH group (P = .0086, P = .013) but were not significant at 1-year follow-up (P = .11, P = .22). Conclusions: Opening of the suture with RME was more anterior and inferior, and the QH did not open the midpalatal suture at all. More buccal bone loss and fenestrations were seen on the permanent first molar in patients treated with conventional QH than RME anchored to deciduous teeth., This study was supported by the Regional Research Council.

Objectives: To assess skeletal and dental effects and evaluate possible side effects of maxillary expansion with two different appliances, directly after expansion and 1 year postexpansion. Materials and Methods: Forty-two patients with unilateral posterior crossbite (mean 9.5 +/- 0.9 years) were randomized to either rapid maxillary expansion (RME) banded on the deciduous second molars and bonded to the primary canines or slow expansion with quad helix (QH) on the permanent first molars. Cone-beam computed tomography records were taken at baseline, directly after correction of the posterior crossbite and at follow-up 1 year after expansion. Results: All patients were analyzed. RME opened the midpalatal suture more anteriorly and inferiorly (mean 4.1 mm) and less posteriorly and superiorly (mean 1.0 mm). No effect on midpalatal suture could be shown in the QH group after expansion, P < .001. Buccal bone width had significantly decreased (P < .001) in the QH group compared with the RME group. Buccal fenestrations and root resorption on the left first molar had a higher prevalence directly after expansion finished in the QH group (P = .0086, P = .013) but were not significant at 1-year follow-up (P = .11, P = .22). Conclusions: Opening of the suture with RME was more anterior and inferior, and the QH did not open the midpalatal suture at all. More buccal bone loss and fenestrations were seen on the permanent first molar in patients treated with conventional QH than RME anchored to deciduous teeth.

Background: Unilateral posterior crossbite is a common malocclusion, and early treatment is recommended to enable normal growth. There are several possibilities regarding choice of appliances used for correcting this malocclusion; however, when treatment is financed by public funds the decision needs to be based not only on the effects but also on the effect in relation to the costs. Objectives: The aim was to perform a cost-effectiveness analysis comparing quad helix (QH) and rapid maxillary expanders (RME; hyrax-type) in children in the early mixed dentition. Material and methods: Seventy-two patients were randomized to treatment with either QH or RME, at two different centres. Data were collected from the patient's medical records regarding success rate, number of visits, total treatment time, emergency visits, and so forth, together with answers from patient questionnaires concerning absence from school and use of analgesics. A cost-effectiveness analysis with both an intention-to-treat (ITT) and a per-protocol approach was performed, as well as a deterministic sensitivity analysis. Results: The success rate, one year after the completion of the expansion, was equal between groups according to the ITT approach. From a healthcare perspective, the mean cost difference between RME and QH was 32.05 in favour of QH (P = 0.583; NS). From a societal perspective, the mean cost difference was 32.61 in favour of QH (P = 0.742; NS). The total appliance cost alone was higher in the RME group 202.67 resp. 155.58 in the QH group (P = 0.001). The probability of RME having a higher cost was 71% from a healthcare perspective and 62.7% from a societal perspective. The total treatment time was 97 days longer in the QH group. In the deterministic sensitivity analysis, when using a higher valuation of the children's educational loss, the QH becomes 58 more costly than the RME. There was a statistically significant differenc

BACKGROUND: Unilateral posterior crossbite is a common malocclusion, and early treatment is recommended to enable normal growth. There are several possibilities regarding choice of appliances used for correcting this malocclusion; however, when treatment is financed by public funds the decision needs to be based not only on the effects but also on the effect in relation to the costs. OBJECTIVES: The aim was to perform a cost-effectiveness analysis comparing quad helix (QH) and rapid maxillary expanders (RME; hyrax-type) in children in the early mixed dentition. MATERIAL AND METHODS: Seventy-two patients were randomized to treatment with either QH or RME, at two different centres. Data were collected from the patient's medical records regarding success rate, number of visits, total treatment time, emergency visits, and so forth, together with answers from patient questionnaires concerning absence from school and use of analgesics. A cost-effectiveness analysis with both an intention-to-treat (ITT) and a per-protocol approach was performed, as well as a deterministic sensitivity analysis. RESULTS: The success rate, one year after the completion of the expansion, was equal between groups according to the ITT approach. From a healthcare perspective, the mean cost difference between RME and QH was €32.05 in favour of QH (P = 0.583; NS). From a societal perspective, the mean cost difference was €32.61 in favour of QH (P = 0.742; NS). The total appliance cost alone was higher in the RME group €202.67 resp. €155.58 in the QH group (P = 0.001). The probability of RME having a higher cost was 71% from a healthcare perspective and 62.7% from a societal perspective. The total treatment time was 97 days longer in the QH group. In the deterministic sensitivity analysis, when using a higher valuation of the children's educational loss, the QH becomes €58 more costly than the RME. There was a statistically significant difference in chair time and visits between centres (P < 0.00

Objective: The purpose of the research was to com-pare the dimensions of the upper jaw between different age groups for the installation of mini-implants for rapid maxillary expansion. Materials and Methods: The study was descriptive, retroprospective and observational. Cone beam computed tomography was used for the evaluation of 30 patients between 7 and 56 years of age, divided into three groups, ten up to 14 years, ten from 15 to 30 years, and ten from 31 years and older. The premolar and molar regions were selected for the measurement of the maxilla in the coronal plane, both bone and soft tissue. To compare the measurements, the Kruskal Wallis and Mann-Whitney U tests were used. Results: No statistically significant differences were found between the groups. The thicknesses of the bone tissue decreased from the first premolar to the second molar from 9.48 +/-3.71 mm to 5.40 +/-2.80 mm respectively, while the soft tissue thicknesses were more homogeneous with measurements of 0.56 +/-0.74 mm to 2.76 +/- 2.42 mm. Conclusions: The dimensions of the bone and soft tis-sue of the upper jaw, evaluated vertically for the installa-tion of mini-implants, were similar in all the age groups studied, with larger dimensions in men than in women at the premolar level. The dimensions of the maxilla for the palatal miniimplants were close to 9 mm in bone tissue and 3 mm of soft tissue at the level of premolars and 5 mm in hard tissue with 1 mm of soft tissue at the level of molars., Objetivo: El propósito de la investigación fue comparar las dimensiones del maxilar superior entre diferentes grupos de edad para la instalación de mini implantes de expansión rápida maxilar (ERM). Materiales y Métodos: El estudio fue descriptivo, retro-prospectivo y observacional. Se utilizaron tomografías computarizadas de haz cónico para la evaluación de 30 pacientes entre 7 a 56 años de edad, divididos en tres grupos, diez hasta 14 años, diez de 15 a 30 años y diez de 31 años a más. Se seleccionaron las regiones de premolares y molares para la medición del maxilar en el plano coronal, tanto de tejido óseo como blando. Para comparar las medidas se utilizaron las pruebas Kruskal Wallis y U de Mann-Whitney. Resultados: No se encontraron diferencias estadística-mente significativas entre los grupos. Los grosores del tejido óseo fueron disminuyendo desde el primer premolar hasta el segundo molar de 9.48 +/-3.71 mm hasta 5.40 +/-2.80 mm respectivamente, mientras que los de tejido blando fueron más homogéneos con medidas de 0.56 +/-0.74 mm hasta 2.76 +/-2.42 mm. Conclusión: Las dimensiones del tejido óseo y blando del maxilar superior, evaluadas en sentido vertical para la instalación de mini implantes, fueron similares en todos los grupos de edad estudiados, con mayores dimensiones en hombres que en mujeres a nivel de premolares. Las dimensiones del maxilar para los mini implantes palatinos se acercaron a los 9 mm en el tejido óseo y 3 mm de tejido blando a nivel de premolares y 5 mm en tejido duro con 1 mm de tejido blando a nivel de molares.

SARPE is a surgical procedure used to correct transverse maxillary discrepancies in skeletally mature patients, combining the use of orthopedic and orthodontic appliances and distraction osteotomies to achieve expansion of the maxillary and controlled expansion of soft tissues in short periods of time. Discrepancies on its effectiveness have been reported and no updated systematic review in Spanish on the effectiveness of SARPE was found. Therefore, this paper aims to determine the effectiveness of SARPE in adults based on a systematic and updated review of the literature. For this purpose, a search for scientific articles was carried out in the main international databases to identify studies published since 2017: Science Direct, Sage Pub, Springer Link, Wiley Library Online, Scopus, Cochrane Library, Cochrane CENTRAL, Trip Database, Medline, Europe PMC, and Biblioteca Virtual de Salud. The search provided 512 titles. After eligibility assessment, 17 articles, eight clinical trials and nine systematic reviews that met the inclusion criteria were included. Variability was found in the design of the studies regarding surgical techniques, type of expanders, periods of follow-up, and imagological evaluation. All treatment modalities significantly increase the width of the transverse maxillary dental and skeletal arch comparing baseline and follow-up measurements, although SARPE was more effective when it was combined with pterygomaxillary disjunction. Studies agree that the available evidence is insufficient, since the majority did not observe statistically significant differences between groups. Therefore, to confirm the effectiveness and stability of SARPE, more controlled clinical trials with longer follow-up periods are required, using 3D imaging assessment., La SARPE es un procedimiento quirúrgico para corregir discrepancias maxilares transversales en pacientes esqueléticamente maduros. Combina el uso de aparatos ortopédicos y ortodóncicos y osteotomías por distracción para lograr la expansión del maxilar y expansión controlada de tejidos blandos en poco tiempo. No se encontró una revisión sistemática actualizada en español sobre la efectividad de la SARPE para corregir discrepancias transversales y problemas subsecuentes en pacientes adultos. Por lo tanto, este artículo persigue determinar la efectividad de la SARPE en adultos con base en una revisión sistemática de la literatura publicada en los últimos años (2015-2023). Se realizó una búsqueda de artículos científicos bases de datos especializadas. Se identificaron 512 documentos y se incluyeron ocho ensayos clínicos y nueve revisiones sistemáticas, todos en inglés. Se encontró variabilidad en el diseño de los estudios respecto de las técnicas quirúrgicas, tipo de expansores, periodos de seguimiento y técnicas de evaluación imagenológica. Todas las modalidades de tratamiento aumentan significativamente el ancho del arco dentario y esquelético maxilar transversal comparando las mediciones iniciales y los seguimientos de control. Sin embargo, la SARPE que incluye disyunción pterigomaxilar fue la más efectiva para corregir discrepancias transversales y problemas funcionales y anatómicos asociados en pacientes adultos. Los estudios coinciden en que la evidencia disponible es insuficiente, debido a la ausencia de significancia estadística entre grupos. Por lo tanto, para confirma la efectividad y la estabilidad de la SARPE, se requieren más estudios clínicos controlados con periodos de seguimientos más largos, evaluados mediante 3D.Recibido: 3/2/2023Aceptado: 4/4/2023

This article reviews the orthodontic alternatives for treating pediatric obstructive sleep apnea (OSA). OSA is a multifactorial disease that impairs craniofacial growth and the general health of a developing child and negatively worsens their quality of life. Therefore, it is important to timely diagnose and treat OSA to avoid the progress of the disease, which could otherwise lead to systemic, neurocognitive and social consequences in the patients. In the transverse direction, compression of the maxilla could decrease the diameter of the upper airways and reduce airflow. In the sagittal direction, a retrognathic mandible positioned more posteriorly to the tongue could reduce the available upper airway space and decrease airflow during sleep. Orthopedic treatments for mild to moderate OSA include maxillary expansion using rapid maxillary expansion devices and mandibular advancement using mandibular advancement appliances, which are treatment options only when skeletal discrepancies exist and should be applied after appropriate individual diagnosis for each orthodontic patient. Currently, limited evidence suggests that these therapies could reduce the signs and symptoms and the apnea-hypopnea index (AHI) of OSA.

IntroductionAdenoid and tonsillar hypertrophy in children often leads to adverse respiratory symptoms and obstructive sleep apnea (OSA). Current clinical guidelines from the American Academy of Pediatrics and American Academy of Otolaryngology-Head and Neck Surgery recommend tonsillectomy as the first line of pediatric OSA treatment for children with tonsillar hypertrophy. Rapid palatal expansion (RPE) performed by orthodontists improves obstructive sleep apnea in children by reducing nasal airway resistance, increasing nasal volume, raising tongue posture, and enlarging pharyngeal airway. However, the role of RPE in alleviating adenoid and tonsillar hypertrophy remains elusive. In this study, we aim to evaluate the changes in adenoid and palatine tonsil sizes following RPE using 3D volumetric analysis of cone beam computational tomography (CBCT) imaging.Materials and methodsIn this retrospective cohort study, a total of 60 pediatric patients (mean age: 8.00, range: 5-15, 32 females and 28 males) who had tonsillar hypertrophy (size 3 and 4) were included and divided into the control group (n = 20) and expansion group (n = 40). The control group did not undergo any treatment. The expansion group underwent RPE using a conventional Hyrax expander, activated 0.25 mm per day for 4-6 weeks. Final CBCT scans (T2) were performed 13.8 ± 6.5 months after the initial scan (T1). Pediatric sleep questionnaire (PSQ) and BMI were obtained at each timepoint. Volumetric analysis of adenoid and palatine tonsils was performed using a combination of bony and soft tissue landmarks in CBCT scans through Anatomage Invivo 6 imaging software. Paired t-tests were used to evaluate the difference between the initial and final adenoid and tonsil volumes. p values less than 0.05 were considered statistically significant.ResultsCompared to the control group, the expansion group experienced a statistically significant decrease in both adenoid and tonsil volume. T

Objectives: To assess and compare the three-dimensional treatment changes in palatal surface area and volume using either tooth-borne (TB) or tooth bone-borne (TBB) rapid maxillary expanders and to evaluate the long-term effects of the two devices and the incidence of the relapse between the groups. Materials and Methods: A total of 52 consecutive patients who met the eligibility criteria were recruited and allocated to either the TB group, mean age 9.3 years (standard deviation [SD], 1.3), or the TBB group, mean age 9.5 years (SD, 1.2). Study casts were taken before, directly after, 1 year after, and 5 years after expansion. Study casts were digitized, superimposed, and evaluated. Participants were randomly allocated in blocks of different sizes using the concealed allocation principle in a 1:1 ratio. Results: Changes in palatal volume, palatal surface area, and palatal projection area within and between the groups up to 5 years after expansion followed the same pattern and did not show any statistically significant differences between the groups. Relapse was seen in 15% of the patients. It seemed that open-bite and a Class III growth pattern could be assumed as prognosis-deteriorating factors in regard to stability of the treatment. Conclusions: There were no significant differences between the TB and TBB groups in palatal volume, palatal shell area, or palatal projection area directly after expansion or at 1 year and 5 years after expansion, which implies that the two devices gave rise to the same immediate and long-term outcomes. (Angle Orthod. 2022;92:589-597.)

Objetivos: exponer los diferentes métodos más actuales para realizar SARPE de una forma mínimamente invasiva. Material y Método: La búsqueda se llevó a cabo a través de las bases de datos recomendadas: Pubmed, Cochrane, Scopus y Google Académico. La búsqueda inicial fue de 224 artículos, una vez aplicados los criterios de inclusión, la selección final fue de 13 artículos. Resultados: Se ha confeccionado una tabla clasificando los artículos en cuatro grupos: título, autor, revista/fuente, año, resumen y conclusión. Además de analizar los resultados obtenidos en diferentes gráficas. Conclusiones: Todas las técnicas descritas en este trabajo para realizar una SARPE mínimamente invasiva son eficaces y seguras. Desde “Twist Technique” hasta las cirugías llevadas a cabo con piezoléctrico, endoscopia o láser de baja intensidad. Entre sus ventajas destacan un mejor postoperatorio, resultado estético y comodidad del paciente., Objectives: to expose the most current different methods to perform SARPE in a minimally invasive way. Material and Method: The search was carried out through the recommended databases: Pubmed, Cochrane, Scopus and Google Scholar. The initial search was 224 articles, once the inclusion criteria were applied, the final selection was 13 articles. Results: A table has been prepared classifying the review into four groups: title, author, magazine / source, year, summary and conclusion. In addition to analyzing the results obtained in different graphs. Conclusions: All the techniques described in this work to perform a minimally invasive SARPE are variable and safe. From “Twist Technique” to surgeries performed with piezoelectric, endoscopic or low intensity laser. Among its advantages, a better postoperative, aesthetic result and patient comfort.

BackgroundMiniscrew-assisted rapid palatal expansion (MARPE) has been adopted in recent years to expand the maxilla in late adolescence and adult patients. Maxillary Skeletal Expander (MSE) is a device that exploits the principles of skeletal anchorage to transmit the expansion force directly to the maxillary bony structures and is characterized by the miniscrews' engagement of the palatal and nasal cortical bone layers. In the literature, it has been reported that the zygomatic buttress is a major constraint that hampers the lateral movement of maxilla, since maxilla is located medially to the zygomatic arches. The objective of the present study is to analyze the changes in the zygomatic bone, maxillary bone, and zygomatic arches and to localize the center of rotation for the zygomaticomaxillary complex in the horizontal plane after treatment with MSE, using high-resolution cone-beam computed tomography (CBCT) images.MethodsFifteen subjects with a mean age of 17.2 (± 4.2) years were treated with MSE. CBCT records were taken before and after miniscrew-assisted maxillary expansion; three linear and four angular parameters were identified in the axial zygomatic section (AZS) and were compared from pre-treatment to post-treatment using the Wilcoxon signed rank test.ResultsAnterior inter-maxillary distance increased by 2.8 mm, posterior inter-zygomatic distance by 2.4 mm, angle of the zygomatic process of the temporal bone by 1.7° and 2.1° (right and left side) (P < 0.01). Changes in posterior inter-temporal distance and zygomaticotemporal angle were negligible (P > 0.05).ConclusionsIn the horizontal plane, the maxillary and zygomatic bones and the whole zygomatic arch were significantly displaced in a lateral direction after treatment with MSE. The center of rotation for the zygomaticomaxillary complex was located near the proximal portion of the zygomatic process of the temporal bone, more posteriorly and more laterally than what has been rep

BackgroundMini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture.MethodsFifteen subjects (mean age of 17.2 years; range, 13.9-26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher's exact test was used.ResultsRegarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P < 0.05). No significant differences were found in the magnitude and frequency of suture opening between males and females. Correlation between age and suture op

BackgroundMini-implant-assisted rapid palatal expansion (MARPE) appliances have been developed with the aim to enhance the orthopedic effect induced by rapid maxillary expansion (RME). Maxillary Skeletal Expander (MSE) is a particular type of MARPE appliance characterized by the presence of four mini-implants positioned in the posterior part of the palate with bi-cortical engagement. The aim of the present study is to evaluate the MSE effects on the midpalatal and pterygopalatine sutures in late adolescents, using high-resolution CBCT. Specific aims are to define the magnitude and sagittal parallelism of midpalatal suture opening, to measure the extent of transverse asymmetry of split, and to illustrate the possibility of splitting the pterygopalatine suture.MethodsFifteen subjects (mean age of 17.2 years; range, 13.9-26.2 years) were treated with MSE. Pre- and post-treatment CBCT exams were taken and superimposed. A novel methodology based on three new reference planes was utilized to analyze the sutural changes. Parameters were compared from pre- to post-treatment and between genders non-parametrically using the Wilcoxon sign rank test. For the frequency of openings in the lower part of the pterygopalatine suture, the Fisher's exact test was used.ResultsRegarding the magnitude of midpalatal suture opening, the split at anterior nasal spine (ANS) and at posterior nasal spine (PNS) was 4.8 and 4.3 mm, respectively. The amount of split at PNS was 90% of that at ANS, showing that the opening of the midpalatal suture was almost perfectly parallel antero-posteriorly. On average, one half of the anterior nasal spine (ANS) moved more than the contralateral one by 1.1 mm. Openings between the lateral and medial plates of the pterygoid process were detectable in 53% of the sutures (P < 0.05). No significant differences were found in the magnitude and frequency of suture opening between males and females. Correlation between age and suture op

IntroductionBone-borne palatal expansion relies on mini-implant stability for successful orthopedic expansion. The large magnitude of applied force experienced by mini-implants during bone-borne expansion may lead to high failure rates. Use of bicortical mini-implant anchorage rather than monocortical anchorage may improve mini-implant stability. The aims of this study were to analyze and compare the effects of bicortical and monocortical anchorages on stress distribution and displacement during bone-borne palatal expansion using finite element analysis.MethodsTwo skull models were constructed to represent expansion before and after midpalatal suture opening. Three clinical situations with varying mini-implant insertion depths were studied in each skull model: monocortical, 1-mm bicortical, and 2.5-mm bicortical. Finite element analysis simulations were performed for each clinical situation in both skull models. Von Mises stress distribution and transverse displacement were evaluated for all models.ResultsPeri-implant stress was greater in the monocortical anchorage model compared with both bicortical anchorage models. In addition, transverse displacement was greater and more parallel in the coronal plane for both bicortical models compared with the monocortical model. Minimal differences were observed between the 1-mm and the 2.5-mm bicortical models for both peri-implant stress and transverse displacement.ConclusionsBicortical mini-implant anchorage results in improved mini-implant stability, decreased mini-implant deformation and fracture, more parallel expansion in the coronal plane, and increased expansion during bone-borne palatal expansion. However, the depth of bicortical mini-implant anchorage was not significant.

IntroductionThe aims of this study were to evaluate the effects of rapid palatal expansion on the craniofacial skeleton of a patient with unilateral cleft lip and palate (UCLP) and to predict the points of force application for optimal expansion using a 3-dimensional finite element model.MethodsA 3-dimensional finite element model of the craniofacial complex with UCLP was generated from spiral computed tomographic scans with imaging software (Mimics, version 13.1; Materialise, Leuven, Belgium). This model was imported into the finite element solver (version 12.0; ANSYS, Canonsburg, Pa) to evaluate transverse expansion forces from rapid palatal expansion. Finite element analysis was performed with transverse expansion to achieve 5 mm of anterolateral expansion of the collapsed minor segment to simulate correction of the anterior crossbite in a patient with UCLP.ResultsHigh-stress concentrations were observed at the body of the sphenoid, medial to the orbit, and at the inferior area of the zygomatic process of the maxilla. The craniofacial stress distribution was asymmetric, with higher stress levels on the cleft side. When forces were applied more anteriorly on the collapsed minor segment and more posteriorly on the major segment, there was greater expansion of the anterior region of the minor segment with minimal expansion of the major segment.ConclusionsThe transverse expansion forces from rapid palatal expansion are distributed to the 3 maxillary buttresses. Finite element analysis is an appropriate tool to study and predict the points of force application for better controlled expansion in patients with UCLP.

AIM: The aim of this study is to report three cases that needed myofunctional and orthodontic treatment and the good results achieved after the therapy. Orthodontic treatment alone, in presence of bad habits, is not enough to solve the orthodontic issues, so it needs to be combined with myofunctional treatment.

Transversal discrepancies represent a common occlusion malocclusion and is treated early once detected. Patient assessment has to be carefully performed to establish a proper diagnosis and an ideal treatment. Is important to determine the etiology of the malocclusion because the treatment is different for a dental origin than an skeletal origin or when they are mixed with a functional alteration. Patient age, problem magnitude and stability also influence appliance selection. An ideal treatment is stable when is focused on correcting the etiology of the problem. Several articles can be found in the literature reporting different treatment options. A treatment protocol as a way of standardizing the procedures is important for the construction of future investigations., Los problemas transversales son considerados alteraciones comunes, necesarias de tratar tempranamente. Es importante establecer un diagnóstico adecuado para determinar la etiología de la maloclusión. Es diferente el enfoque sí es una mordida cruzada de origen dental, una mordida cruzada esquelética o una combinación de las anteriores con un problema funcional. Además se debe considerar la edad del paciente, la magnitud del problema y la estabilidad de su corrección. El tratamiento más idóneo sería aquel que busca corregir la etiología de la alteración para asegurar su estabilidad. En la literatura se encuentran artículos que reportan diferentes opciones de tratamiento, por tanto se pretende realizar un protocolo de tratamiento para los pacientes para estandarizar procesos que faciliten investigaciones futuras.

Transversal discrepancies represent a common occlusion malocclusion and is treated early once detected. Patient assessment has to be carefully performed to establish a proper diagnosis and an ideal treatment. Is important to determine the etiology of the malocclusion because the treatment is different for a dental origin than an skeletal origin or when they are mixed with a functional alteration. Patient age, problem magnitude and stability also influence appliance selection. An ideal treatment is stable when is focused on correcting the etiology of the problem. Several articles can be found in the literature reporting different treatment options. A treatment protocol as a way of standardizing the procedures is important for the construction of future investigations., Los problemas transversales son considerados alteraciones comunes, necesarias de tratar tempranamente. Es importante establecer un diagnóstico adecuado para determinar la etiología de la maloclusión. Es diferente el enfoque sí es una mordida cruzada de origen dental, una mordida cruzada esquelética o una combinación de las anteriores con un problema funcional. Además se debe considerar la edad del paciente, la magnitud del problema y la estabilidad de su corrección. El tratamiento más idóneo sería aquel que busca corregir la etiología de la alteración para asegurar su estabilidad. En la literatura se encuentran artículos que reportan diferentes opciones de tratamiento, por tanto se pretende realizar un protocolo de tratamiento para los pacientes para estandarizar procesos que faciliten investigaciones futuras.

The different sagittal, vertical or transversal skeletal dysmorphosis can be treated with orthodontic or orthopaedic appliances. Certain limits of treatment will be due to the age of the patient, the importance of the skeletal dysmorphosis, technical limits of the orthodontic appliances or the motivation and compliance needed from the patient. For this reason an orthodontic treatment combined with orthognathic surgery may be indicated. Nevertheless the combined orthodontic-surgical treatment has also its limitations and specific treatment needs from orthodontist and maxillo-facial surgeon.