EXPANSION Method of Gaining Space
EXPANSION Method of Gaining Space
EXPANSION Method of Gaining Space
OF
GAINING SPACE-
EXPANSION
Emerson C. Angell, For the first time in 1860,
used a Jack screw type of device. (Considered
the father of rapid maxillary expansion)
• This technique was popularized by Oral & ENT surgeons in the early part
of last century.
• Korkhaus & Andrew Hass during the 1950’s re-introduced RME to the
Orthodontic community.
Estimation of. need for expansion
Based on cephalogram ,model analysis: to quantify arch length
tooth material discrepancy. Up to 5mm
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CLASSIFICATION
• Orthopedic: Width of underlying basal bone is increased by
splitting mid palatal suture.
– rapid or slow depending on the rate of expansion.
• Passive: When the muscle forces (buccal & labial) are shielded
away from the dentition, widening of dental arches occurs. This
expansion is the result of intrinsic forces produced by tongue.
Skeletal
Expansion: Dentoalveolar
Removable Fixed
Coffin springs Slow expansion RME Quad helix W arch Arch Wire
Screws.
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Rapid Palatal Expansion
It is a skeletal type of expansion
that involves the separation of the
mid-palatal suture and movement
of the maxillary shelves away
from each other.
ANATOMY
• Midpalatal suture is
formed by the junction of
the three opposing pairs
of bones namely
– Premaxillae
– Maxillae
– Palatine Bone
ANATOMY
• First stage : Covering the infantile period. The
suture is very broad and Y shaped with the
vomerine bone placed in a V shaped groove
between the two halves of the maxilla.
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INDICATION OF R.M.E
1. In subjects, with severe maxillary constriction.
7. Sleep apnea
• Case History
• Clinical examination
• Study models
• Radiographs –
– Maxillary occlusal
– P.A. cephalogram
EFFECTS OF R.M.E
On the maxilla
– Sagittal
– Coronal
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Coronal plane
• 2 halves move away from each other.
• Fulcrum of rotation around the fronto-
maxillary suture.
2.
3.
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Maxillary posterior teeth
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Effect on mandible
Fixed appliances:
Derichsweiler type
Haas type
Isaacson type
BANDED BONDED
Hyrax appliance
Removable appliances
Reliability of these appliances in producing skeletal
expansion is highly questionable.
• If used during the deciduous (or) early mixed dentition
phase produces some effects.
• Consists of a split acrylic plate with a midline screw
retained using clamps on posterior teeth.
• Disadvantages:-
1. Need for patient co-operation
Timms:
Up to 15 yrs:
90° rotation once in the morning & once in the Evening
15-20 yrs :
45° activation 4 times a day. 36
Clinical Tips
• 4/4 extraction postpone.
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SURGICAL ASSISSTED MAXILLARY
EXPANSION
• Indications:
Slow dentoalveolar exp
Constricted upper arch
• Appliance Construction:
1.25mm hard round S.S wire.
U or Omega shaped wire.
Stands 1mm away from palate.
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Retention from Adam’s clasps on U6,U4 or E
Appliance activation.
• Range of activation 2-4 mm before insertion.
Disadvantage
Dislodgement of clasps from the teeth.
Heavy intermittent force.
Patient compliance.
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Expansion plate
• Pierre Robin in 1902 was the
first one who constructed a split
plate which incorporated screw.
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Lower Schwartz appliance
Indications:
• Mild to moderate lower ant crowding,
• Lingual tipping of post teeth.
Activation: once/week
• 0.20 to 0.25mm of expn in midline.
• 3-4months; gain 4-5mm of arch length anteriorly.
Fixed Expansion appliances
Quad/Tri/Bi- Helix
• Evolved- original coffin loop.
2 types:
fixed
removable
Activation
ACTIVATION:
• 2mm/month. Duration 2-3months.
• Remove and then activate.
• 3 months retention.
• Wendell V .Arndt,
• produce light, continuous pressure on mid palatal suture while
simultaneously uprighting, rotating & distalizing the maxillary
1st molars.
• Has adjustable stainless steel extensions and is inserted into
standard horizontal lingual sheaths that are spot welded to the
molar bands.
• Action of appliance is consequence of Ni-Ti shape memory &
transition temperature effects.
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• Ni-Ti as transition temperature of 94°F, when it is
chilled before insertion, it become flexible & can
easily be bent to facilitate placement.
• Maurice C. Corbett
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APPLIANCE SELECTION
• Available in 10 sizes, from 26mm to 44mm.
• Functional Regulator
• Lip Bumper: The lateral arms
remove the resting pressure of the
buccal musculature .Allow the
unopposed action of tongue –
increases arch width
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T.P.A
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Arch Expansion in Fixed Appliances
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SLOW EXPANSION RAPID EXPANSION
• By use of this force the teeth • Results in major change occurring in
alone are supposed to move basal structures of mandible and
maxilla
• Transmit forces ranging from 2-4
pounds. • More than 10-20 pounds
• They cause dento alveolar
expansion. They can separate •
maxillae, particularly in the They can separate maxillae.
deciduous & mixed dentitions. .