Mini-implant selection protocol applied to MARPE

Rapid maxillary expansion (RME) is the therapy of choice to correct skeletal transverse dimension in children and adolescents, associating orthopedic and dental effects. In an attempt to prevent the undesirable dentoalveolar effects and optimize the potential of skeletal expansion in individuals in advanced stages of skeletal maturation, the miniscrew-assisted rapid palatal expander (MARPE) was proposed by Lee et al. in 2010.

Objective:

This paper presents a systematized protocol for selection of miniscrews indicated for MARPE, by the evaluation of cone-beam computed tomographies (CBCT). Variables related with the bone and soft tissue thicknesses at the palatal regions of interest, as well as in relation to the fixation rings of miniscrews of the palatal expander are analyzed and discussed to provide better performance in the clinical practice.

Keywords:
Palatal expansion technique; Orthodontic anchorage procedures; Malocclusion; Transverse maxillary atresia

Authorship

Lincoln Issamu Nojima

Universidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil).Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilUniversidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil).

Matilde da Cunha Gonçalves Nojima

Amanda Carneiro da Cunha

Natan Oliveira Guss

Universidade Federal do Rio de Janeiro, Post-graduation Program in Orthodontics (Rio de Janeiro/RJ, Brazil).Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilUniversidade Federal do Rio de Janeiro, Post-graduation Program in Orthodontics (Rio de Janeiro/RJ, Brazil).

Eduardo Franzotti Sant’Anna

Contact address:
Lincoln Issamu Nojima Av Professor Rodolpho Paulo Rocco, 325 - Ilha do Fundão Rio de Janeiro - RJ - Brasil - CEP: 21941-617 E-mail: linojima@gmail.com

Author contributions

Conceived and designed the study: LN. Data acquisition, analysis or interpretation: LN, ACC, NGO. Writing the article: LN, MCGN, ACC, NGO. Critical revision of the article: MCGN, NGO, EFS. Final approval of the article: LN. Obtained funding: LN. Overall responsibility: LN.

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (8)

Thumbnail

Figure 1
A, B) Clinical photographs in occlusal view, before and after expansion, respectively. C, D) Mesial right and mesial left miniscrews used as anchorage for MARPE, after its removal from the oral cavity.

Thumbnail

Figure 2
A) Initial dental cast. B) Delineation of dotted line referring to the midpalatal suture. C) Positioning of expanding screw coinciding with the midpalatal suture line. D) Delineation of reference lines (in blue), transverse to the midpalatal suture, passing through the center of miniscrews fixation rings mesial and distal to the expanding screw.

Thumbnail

Figure 3
CBCT images illustrating the maxilla in multiplanar sections. A) Sagittal section. B) Coronal section. The axial section should coincide with the occlusal plane, delineated by the cusp tips of molars and incisal edges of maxillary central incisors.

Thumbnail

Figure 4
A) Dental cast illustrating the delineation of reference line (in blue) passing through the miniscrews fixation rings at the mesial region of the expanding screw, extending to the second premolars. B) CBCT images: on the axial section with the reference line (in blue), and on the coronal section evidencing the quantity of bone equidistant to the midpalatal suture, corresponding to the position of the reference line delineated on the axial section (in blue). C) Dental cast with delineation of reference line (in blue), passing through the miniscrews fixation rings at the distal region of the expanding screw and extending to the molars. D) CBCT images: on the axial section, with the reference line (in blue), and on the coronal section evidencing the quantity of bone equidistant to the midpalatal suture, corresponding to the level of the reference line delineated on the axial section (in blue). E) Measurement of width between the miniscrews fixation rings of the expanding screw, assessed with a caliper. F) CBCT images illustrating the measurement of bone and soft tissue height, on the coronal section corresponding to the distal region of the expanding screw.

Thumbnail

Figure 5
Measurement of height of fixation rings of anterior (A) and posterior miniscrews (B); and between them and the palatal surface assessed on the dental cast using a periodontal probe with millimeter marks.

Thumbnail

Figure 6
CBCT image on the coronal section at the distal region of the expanding screw, illustrating the bicortical insertion of miniscrews.

Thumbnail

Figure 7
A, B) CBCT images on the axial section, before and after MARPE. Red arrows indicate the opening of the midpalatal suture. C, D) Clinical photographs, in occlusal view, before and after MARPE, respectively.

Thumbnail

Figure 8
CBCT images. A) Axial section. B) Coronal section at the region of dotted lines (in red, in A). C) Sagittal section at the level of dotted lines (in green, in A), evidencing scarce bone tissue for anchorage of miniscrews in MARPE.

Figure 1 A, B) Clinical photographs in occlusal view, before and after expansion, respectively. C, D) Mesial right and mesial left miniscrews used as anchorage for MARPE, after its removal from the oral cavity.

Figure 2 A) Initial dental cast. B) Delineation of dotted line referring to the midpalatal suture. C) Positioning of expanding screw coinciding with the midpalatal suture line. D) Delineation of reference lines (in blue), transverse to the midpalatal suture, passing through the center of miniscrews fixation rings mesial and distal to the expanding screw.

Figure 3 CBCT images illustrating the maxilla in multiplanar sections. A) Sagittal section. B) Coronal section. The axial section should coincide with the occlusal plane, delineated by the cusp tips of molars and incisal edges of maxillary central incisors.

Figure 4 A) Dental cast illustrating the delineation of reference line (in blue) passing through the miniscrews fixation rings at the mesial region of the expanding screw, extending to the second premolars. B) CBCT images: on the axial section with the reference line (in blue), and on the coronal section evidencing the quantity of bone equidistant to the midpalatal suture, corresponding to the position of the reference line delineated on the axial section (in blue). C) Dental cast with delineation of reference line (in blue), passing through the miniscrews fixation rings at the distal region of the expanding screw and extending to the molars. D) CBCT images: on the axial section, with the reference line (in blue), and on the coronal section evidencing the quantity of bone equidistant to the midpalatal suture, corresponding to the level of the reference line delineated on the axial section (in blue). E) Measurement of width between the miniscrews fixation rings of the expanding screw, assessed with a caliper. F) CBCT images illustrating the measurement of bone and soft tissue height, on the coronal section corresponding to the distal region of the expanding screw.

Figure 5 Measurement of height of fixation rings of anterior (A) and posterior miniscrews (B); and between them and the palatal surface assessed on the dental cast using a periodontal probe with millimeter marks.

Figure 6 CBCT image on the coronal section at the distal region of the expanding screw, illustrating the bicortical insertion of miniscrews.

Figure 7 A, B) CBCT images on the axial section, before and after MARPE. Red arrows indicate the opening of the midpalatal suture. C, D) Clinical photographs, in occlusal view, before and after MARPE, respectively.

Figure 8 CBCT images. A) Axial section. B) Coronal section at the region of dotted lines (in red, in A). C) Sagittal section at the level of dotted lines (in green, in A), evidencing scarce bone tissue for anchorage of miniscrews in MARPE.

How to cite

copy

Dental Press International Av. Luís Teixeira Mendes, 2712 , 87015-001 - Maringá - PR, Tel: (55 44) 3033-9818 - Maringá - PR - Brazil
E-mail: artigos@dentalpress.com.br

Acompanhe os números deste periódico no seu leitor de RSS

Versão para download de PDF

PDF

Inglês

Versões e tradução automática

Versão original do texto

English

Tradução automática

Google Translator
Microsoft Translator

Como citar

RIS

BIBTEX

Outros formatos de citação e exportação:

SciELO - Scientific Electronic Library Online
Rua Dr. Diogo de Faria, 1087 – 9º andar – Vila Clementino 04037-003 São Paulo/SP - Brasil
E-mail: scielo@scielo.org

Leia a Declaração de Acesso Aberto

Métricas

Mini-implant selection protocol applied to MARPE

PlumX

Mensagem

[1] Contact address:
Lincoln Issamu Nojima Av Professor Rodolpho Paulo Rocco, 325 - Ilha do Fundão Rio de Janeiro - RJ - Brasil - CEP: 21941-617 E-mail: linojima@gmail.com