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Aim: The aim of this study is to evaluate whether a transverse maxillary deficit can cause an alteration of vertebral development and therefore of the skeletal maturation comparing the cervical maturation stages index with the hand-wrist index., Materials and Methods: For the study were selected 200 patients aged 7-14 years, equally distributed by gender and divided into 100 study subjects with maxillary deficit and 100 controls without maxillary deficit. The skeletal maturation index (SM according to Fishman) was evaluated and compared with the hand-wrist x-rays and the cervical vertebrae maturation (CVM according to Hassel and Farmann)., Results: Forty-one per cent of the subjects in the test group show a discrepancy between CVM and SM. Among these 73% (30 subjects) present an advanced stage of CVM compared with the corresponding SM. Only 16% of the subjects in the control group show a discrepancy between CVM and SM. Among these 69% (11 subjects) appear in an advanced CVM stage., Conclusion: The analysis of the CVM stage in subjects with transverse maxillary deficit appears to be altered compared with the SM identified through a hand-wrist x-ray. In the case of individuals with transverse maxillary deficit it is advisable to use also a hand-wrist x-ray, thus not relying only on CVM for the evaluation of the skeletal growth stages.

Background: The aim of this retrospective study was to evaluate and compare cephalometrically the skeletal and dental effects of maxillary expansion by the rapid maxillary expander compared to a surgical assisted rapid maxillary expansion., Methods: The records which included 102 patients (50 female, 52 male) with maxillary bilateral cross bite caused by narrowness of the apical base are collected and divided into two treatment groups: the first group (63 patients, 36 male and 27 female) included patients who had been treated with an orthopedic rapid maxillary expander. The second group (39 patients, 16 male, 23 female) included patients who had been treated by a surgical assisted rapid maxillary expansion. For each patient two frontal cephalograms, one taken before treatment (T0) and a second one after the retention phase (T1), were analyzed. Descriptive statistics included the means and standard deviations (SD). The mean differences in cephalometric measurements at T0 and T1 were examined. Statistical analysis was undertaken using a T test for paired samples. Statistical significance was considered at P<0.05 level., Results: Both the therapeutic approaches have shown a statistically significant widening of the maxilla and a symmetrization of the two halves of the bone, at both skeletal and dental levels., Conclusions: Rapid maxillary expander and surgically assisted rapid maxillary expansion SARME can be used for the resolution of malocclusions characterized by a transverse maxillary hypoplasia. The choice between RME and SARME is linked to the age of the patient, and the biological stage of the maxillary suture.

Background: The aim of this retrospective study was to cephalometrically evaluate the skeletal and dental effects of the transverse sagittal maxillary expander (TSME), for the correction of sagittal and transverse maxillary deficiency in class I, II, and III malocclusions., Methods: The sample for this retrospective study included 45 patients (mean age, 8.4 years; 26 females, 19 males; 15 skeletal class I subjects, 15 skeletal class II subjects, and 15 skeletal class III subjects) with maxillary bilateral cross-bite. For each patient, a lateral cephalogram was obtained before treatment and at the end of the retention period. Changes in the groups during the observation period were calculated, compared, and statistically analyzed with a t-test., Results: The cephalometric values before T0 and T1 showed significant changes., Conclusions: The TSME can produce skeletal changes due to the transverse force and sagittal effects on the maxillary alveolar process. These modifications have benefic effects in classes I, II, and III. The data obtained in this study permit us to underline the fact that TSME can be used in all of the skeletal classes, with good vertical and sagittal results.

The transversal sagittal maxillary expander (TSME) is a fixed device designed to develop arch form in patients with constricted dental arches. The present article describes a modified TSME appliance, the activation method, the therapeutic benefits as well as clinical advantages. The appliance has two molar bands, a Hyrax-type transverse expansion screw, one 0.045-inch wire extending from the molar band to the palatal surface of the central incisor in the emiarch crossbite and an 8 mm-Hyrax-type screw attached to this wire between the molar band and the incisor. A buccal arm with a terminal loop is welded to the band in the emiarch and it is extended to the labial surface on the central incisor on the side opposite to the crossbite and the maxillary midline deviation. The modified TSME appliance described in this paper are specifically designed for anteroposterior and transverse development. It has a sagittal effect on the maxillary alveolar process and at the same time allow to restore the correct transverse maxillary diameters.

Aim: The aim of this work consists in analyzing the consequences of RME on the nasal septum., Methods: The sample included 140 patients presenting a skeletal maxillary transverse constriction. Two groups were constructed. The first group containing 100 patients presenting a septal deviation more than 1 mm was treated by a Hyrax expander, to correct the transverse dimension. The second group containing 40 patients was not treated because the patients were under pharmacological treatment for neurovascular headache. The protocol of activation in group 1 consisted by activation of the transverse screw one-quarter turn twice a day for 15 days. Then the appliance was left in place for passive retention. The skeletal variations induced by RME have been made through cephalometric evaluations obtained before therapy (T0), at the removal of the appliance (T1) and after 6 months of manteinance (T2). A lapse of time of six months passed between T0 and T1., Results: This study demonstrates how RME can increase the length of the septum, improving its possible deviations and growth disturbance., Conclusion: Palatal expansion technique is a valid therapeutic option, which allows to increase nasal cavity volume and it can also have a favorable effects on the growth of the maxillary complex.

Aim: The aim was to compare the skeletal and dental effects of a new type of a modified Hyrax rapid palatal expander with vestibular arm with the Hyrax expander in patients with maxillary asymmetric deficiencies., Methods: This study includes 50 growing patients in early mixed dentition, suffering from a maxillary narrowness combined with the exfoliation of one or more deciduous teeth, a monolateral or bilateral crossbite and a deviation of the upper midline. Twenty-five patients were treated with a modified Hyrax expander and 25 patients with a Hyrax expander (RME). Dental casts and posteroanterior radiographs were obtained before treatment [T0] and six months after maxillary expansion [T1]. Measurements of intermolar width, intercanine width, arch length, arch perimeter, space between lateral incisor and I deciduous molar, and midline discrepancy were made with a digital calliper on photocopies taken from the dental casts. Cephalometric tracing on frontal teleradiographies were evaluated., Results: Results showed no statistically significant differences between T0 and T1 in the modified RME appliance and the RME except lateral drift of incisor and space between lateral incisor and first deciduous molar. The modified RME permitted to obtain the restoration of the coincidence of the midlines of almost 5/6 mm and to create 7 to 9 mm of space in the canine area., Conclusion: both the appliances are effective in correcting maxillary narrowness but the modified hyrax expander represents the best choice for the correction of upper midline deviations, and to restore the correct symmetry of dental midlines.

This article describes a case report of a patient treated by the modified version of the Hyrax rapid palatal expander described by Farronato et al. in 2009. This device can be utilized for the treatment of patients in mixed dentition who, due to the maxillary hypoplasia and to the premature exfoliation of some deciduous teeth, manifest a migration of the permanent incisors with a reduction or closure of the space for the permanent teeth substituting those previously exfoliated. This expander presents a vestibular arm for correcting maxillary asymmetric transverse discrepancies. The activation method, the therapeutic benefits as well as the clinical advantages are described. The use of this appliance allows to restore the correct transverse maxillary diameters, to regain space and at the same time to restore the symmetry of the midlines up to 5-6 mm. Moreover, a recovery of the arch length can be obtained, as demonstrated by the case report presented. The expander with vestibular arm represents an interceptive treatment which can reduce the duration of the orthodontic therapy with fixed appliances.

Objective: Rapid Palatal Expansion (RPE) is an orthodontic procedure commonly used to widen the maxilla. Aim of this study is the description of the effects produced by RPE in two patients affected by Bilateral Congenital Choanal Atresia (BCCA) operated in infancy and who were scheduled for a secondary endoscopical surgical correction., Methods: The two cases presented were studied through Postero Anterior and Submental Vertex cephalometric x-rays, and TC-Scans pre and 12 months post expansion., Results: Both nasal and choanal widths were increased 12 months post expansion of an amount which was equivalent to 30% of the defective bony width. Endoscopically the expansion of the lumen was more evident given the associated soft tissue improvement. In both cases secondary surgery was avoided., Conclusion: The cooperation between ENT surgeon and orthodontist may allow for an reduction in the burden of treatment of children affected by BCCA., (Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.)

The aim of the research was to study the interrelationship between the primary neurovascular headaches, the various levels dimension of nasal pyramid and the rapid palatal expansion. Twenty-five patients, of both sexes and on developmental age, were studied before and after the rapid palatal expansion. All patients showed palatal hypoplasia and were suffering from primary neurovascular headache. The research was based on the cephalometric and rhinomanometric data. The radiographic documentation of each patient consisted of three postero-anterior teleradiographic projection; the first before application of the disjunction device, the second immediately after disjunction and the third at the end of the contention period. The rhinomanometric evaluation studied the reduction of nasal resistance values before and after palatal expansion. In all patients a constant increase in the values relating both skeletal and dental structures was observed. The nasal septum, if deviated, appeared straightend. The nasal resistances were decreased. The concomitant headache symptomatology presented resolution or recovery in the 98% of treated patients. The results should confirm the hypothesis of the central-peripheral theory of "primary headaches" and the possibility to treat the primary headaches by rapid palatal disjunction in eliminating the stenosis at various levels of nasal pyramid.