Introduction: Maxillary transverse deficiency is a highly prevalent malocclusion present in all age groups, from primary to permanent dentition. If not treated on time, it can aggravate and evolve to a more complex malocclusion, hindering facial growth and development. Aside from the occlusal consequences, the deficiency can bring about serious respiratory problems as well, due to the consequent nasal constriction usually associated. In growing patients, this condition can be easily handled with a conventional rapid palatal expansion. However, mature patients are frequently subjected to a more invasive procedure, the surgically-assisted rapid palatal expansion (SARPE). More recently, researches have demonstrated that it is possible to expand the maxilla in grown patients without performing osteotomies, but using microimplants anchorage instead. This novel technique is called microimplant-assisted rapid palatal expansion (MARPE). Objective: The aim of the present article was to demonstrate and discuss a MARPE technique developed by Dr. Won Moon and colleagues at University of California - Los Angeles (UCLA).Methods: All laboratory and clinical steps needed for its correct execution are thoroughly described. For better comprehension, a mature patient case is reported, detailing all the treatment progress and results obtained.Conclusion: It was concluded that the demonstrated technique could be an interesting alternative to SARPE in the majority of non-growing patients with maxillary transverse deficiency. The present patient showed important occlusal and respiratory benefits following the procedure, without requiring any surgical intervention.
To determine how low intensity pulsed ultrasound alters gene expression in rat bone marrow stromal cells and to see if combining this stimulation with BMP-2, cells were pre-cultured for eight days in the presence of 50 &ml ascorbic acid and then exposed to either low intensity US or 100ng/ml BMP-2 or both combined, beginning on the first, third fifth or seventh day of culture so that cells were exposed to the stimuli for one, three, five or seven days. Real time PCR was used to determine the effect of these treatments on gene expression of several genes associated with osteogenesis. The expression of some of the genes (Cbfa-lIRunx2, IGFreceptor, Alk-3, alkaline phosphatase, osteopontin, TGF-PI, BMP-7) was increased compared to untreated controls. Combination of US and BMP-2 treatment did not lead to synergy of the two stimuli. Cbfa-1 stimulation occurred more quickly with US than with BMP-2.Increases in gene expression were greatest after 3 days exposure to US, with similar results for BMP-2 treatment implying that there may be a time dependence for the stimulus of osteogenic gene expression in stromal cells.
The simulated computer model used in this investigation suggests that a face-bow with a symmetrically soldered joint and arms of equal lengths used in combination with a transpalatal arch is the best headgear option when asymmetric movement of upper molars is desired.
This study presents the development and validation of a fibre Bragg gratings (FBGs)-based sensor system for the assessment of strain in the midpalatal suture in subjects using rapid palatal expanders (RPEs). The ex-vivo experiments were made by means of positioning two RPEs in a porcine palatal region. The RPEs used were the Hyrax, a tooth-borne expander and MARPE (microimplant-assisted rapid palatal expansion), a bone-borne expander. In order to define the regions in the palatal region for the sensors positioning, a finite-element analysis was performed in a porcine head subjected to the loadings caused by an RPE. In addition, a strain transfer model was used to obtain a correction coefficient that approximates the strain estimated by the FBG to the actual strain in the structure under shear and normal stress. Results show high linearity in the sensors characterisation tests with the advantages of compactness, intrinsic safe operation and multiplexing capabilities of FBGs. In the RPE analysis, a higher strain was estimated in the anterior region, which is in accordance with the simulation and previously reported results, where MARPE showed a higher strain (with an exponential pattern) than Hyrax as the number of activations increase. Fig. 9 Comparison of the strain in the anterior region as a function of the RPE activation between the Hyrax and MARPE appliances
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