Stress distribution and displacement of three different types of micro-implant assisted rapid maxillary expansion (MARME): a three-dimensional finite element study.

BACKGROUND/OBJECTIVE: Until 2010, adults underwent surgical treatment for maxillary expansion; however, with the advent of micro-implant-assisted rapid maxillary expansion (MARME), the availability of less invasive treatment options has increased. Nevertheless, individuals with severe transverse maxillary deficiency do not benefit from this therapy. This has aroused interest in creating a new device that allows the benefit of maxillary expansion for these individuals. The aim of this study was to evaluate the efficacy of three MARME models according to tension points, force distribution, and areas of concentration in the craniofacial complex when transverse forces are applied using finite element analysis. MATERIALS AND METHODS: Digital modeling of the three MARME models was performed. Model A comprised five components: one body screw expander and four adjustable arms with rings for mini-implant insertion. These arms have an individualized height adjustment that allows MARME positioning according to the patient's palatal anatomy, thereby preventing body screw expander collision with the lateral mucosa in severe cases of maxillary deficiency. Model B was a maxillary expander with screw rings joined to the body, and model C was similar to model B, except that model C had open rings for the insertion of the mini-implants. Through the MEF (Ansys software), the stresses, distribution, and area of concentration of the stresses were evaluated when transverse forces of 7.85 N were applied. RESULTS: The three models maintained the following pattern: model C presented weak stress peaks with limited distribution and lower concentration area, model B obtained median stress peaks with better distribution when compared to that of model C, and model A showed better stress distribution and larger concentration area. In model A, tensions were located in the lateral lamina of the pterygoid process, which is an important site for maxillary expansion. The limitation of the present study was that it did not include the periodontal tissues and muscles in the finite element method evaluation. CONCLUSIONS: Model A showed the best stress distribution conditions. In cases of severe atresia, model A seems to be an excellent option.

Effects of mandibular advancement surgery combined with minimal maxillary displacement on the volume and most restricted cross-sectional area of the pharyngeal airway.

The purpose of this study was to evaluate changes in the volume and most restricted cross-sectional area of the pharyngeal airway as a result of mandibular advancement surgery with minimal maxillary displacement, and to ascertain the change in height of this restricted area and whether gender and age could influence these results. Cone beam computed tomography scans were obtained from 25 patients (seven male and 18 female, average age 35.5 years). The measurements were done using the InVivoDental software (version 5.0). Comparisons were made between measurements taken prior to treatment (T1) and postsurgery (T2, average 6.3 months after surgery). No variation was detected on the scans with regard to head position, which could influence the pharynx airway. Surgery significantly increased the pharynx airway volume at the total (P<0.0001), upper (P=0.0001), and lower (P<0.0001) levels, with respective enlargements of 54.5%, 37.0%, and 91.3%. Gender and age did not influence this increase. A significant enlargement in the minimum area of the pharynx airway was detected (P<0.0001), which changed in shape from a tapering to a rounded shape. Using binomial and multiple logistic regression tests, this constricted site presented an unpredictable change in position as a result of surgery, with no association to gender (P=0.0745) or age (P=0.5879).