A new palatal distractor device for bodily movement of maxillary bones by rigid self-locking miniplates and screws system.

METHODS: A new palatal distractor device for bodily movement of the maxillary bones after complete segmented Le Fort I osteotomy for 1-stage transversal distraction and tridimensional repositioning on 1 patient is presented. The new distractor has an intrinsic tridimensional rigidity also in the fixation system by self-locking miniplates and screws for better control of the 2 maxillary fragments during distraction. RESULTS: Le Fort I distraction and repositioning procedure in association with a bilateral sagittal split osteotomy were performed on 1 patient with complete solution of the cross-bite and class III malocclusion. Results of dental and cephalometric analysis performed before surgery (T1), after surgery and distraction time (T2), and 18 months after surgery and orthodontic appliance removal (T3) are reported. CONCLUSIONS: No complications were encountered using the new distractor device. Advantages of this device and technique are presented including improved rigidity of both distraction (jackscrew) and fixation (4 self-locking miniplates and screws) systems resulting in complete control of the position of the 2 maxillary fragments during distraction and surgery. In addition, this new device allows resuming palatal distraction in the event of cross-bite relapse without causing dental-related problems or the risks of screw slackening.

One-step transversal palatal distraction and maxillary repositioning: technical considerations, advantages, and long-term stability.

BACKGROUND: Transversal maxillary hypoplasia in adolescence is a frequently seen pathology, which can be treated with a combination of surgery and orthodontic treatment to widen the maxilla in skeletally matured patients.We evaluated the advantages of a new surgical technique: Le Fort I distraction osteogenesis using a bone-borne device. Because relapse is one of the main problems in surgical maxillary expansion, long-term stability of this new technique was evaluated. METHODS: Data from 4 adult patients with maxillary restriction, class III malocclusion, or maxillary malposition were collected preoperatively, 4 months after distraction, and 5 years after distraction. Measurements were recorded on dental models to detect palatal expansion at dental level; cephalograms by lateral and posteroanterior plane were analyzed to detect maxillary movements. RESULTS: Maxillary measurements were substantially stable 5 years after distractions. Only minor dental movements occurred at the dental analysis after 5 years related to a lack of orthodontic contention without any compromise of the dental result (no crossbite relapse and class I stability). CONCLUSIONS: Le Fort I with down-fracture for expansion and repositioning by bone-borne distractor device can [corrected] be used to simultaneously widen, advance, and vertically reposition the maxilla without causing healing problems, particularly using a rigid distraction device. Long-term stability can be achieved; however, further studies with a larger number of patients will be necessary for better evaluation.

Maxillary constriction treated by a new palatal distractor device: surgical and occlusal evaluations of 10 patients.

PURPOSE: To study the changes in maxillary dimensions after the application of a new distractor on 10 adult patients affected by severe palatal constriction. MATERIALS AND METHODS: The palatal distractor device was made of a Rematitan titanium expansion screw (Dentaurum) welded to 2 titanium miniplates (LEIBINGER) on patient's models. The device was applied using four 8-mm screws, activated 0.20 mm 4 times a day, and blocked for 4 months. The intermolar, interpremolar, and intercanine distances were measured before the palatal distractor device application and 1 week and 4 months after activation. Changes in dental angulation in the frontal plane, the intermolar, and the interpremolar angle variations were measured. RESULTS: There was an increase of the arch perimeter, well correlated with the expansion at dental level, resulting in teeth crowding resolution. The changes in dental angulation in the frontal plane were minimal, indicating mainly a skeletal movement. CONCLUSIONS: The device produces mainly a skeletal movement and a minimal dental angulation movement.