Description of a Digital Work-Flow for CBCT-Guided Construction of Micro-Implant Supported Maxillary Skeletal Expander

Abstract

The introduction of miniscrew-assisted rapid palatal expansion (MARPE) has widened the boundaries of orthodontic skeletal correction of maxillary transversal deficiency to late adolescence and adult patients. In this respect, Maxillary Skeletal Expander (MSE) is a particular device characterized by the engagement of four miniscrews in the palatal and nasal cortical bone layers. Thus, the availability of sufficient supporting bone and the perforation of both cortical laminas (bi-corticalism) are two mandatory parameters for mini-screw stability, especially when orthopedic forces are used. Virtual planning and construction of MSE based on cone-beam computed tomography (CBCT)-derived stereolithography (.stl) files have been recently described in the literature. In this manuscript we described: (a) a user-friendly digital workflow which can provide a predictable placement of maxillary skeletal expander (MSE) appliance according to the patient’s anatomical characteristics, (b) the construction of a positional template of the MSE that allows lab technician to construct the MSE appliance in a reliable and accurate position, according to the virtual project planned by the orthodontist on the patient CBCT scans. We also described a case report of an adult female patient affected by skeletal transversal maxillary deficiency treated with MSE appliance that was projected according to the described workflow.

Effectiveness of Dental and Maxillary Transverse Changes in Tooth-Borne, Bone-Borne, and Hybrid Palatal Expansion through Cone-Beam Tomography: A Systematic Review of the Literature

“…Finally, CBCT has been made safe and simple to plan mini-implant placement in every orthodontic case that required skeletal anchorage [ 47 , 48 ]. The aim of this research is to describe the bone and dental effects, assessed by cone-beam computed tomography (CBCT), of the expansion of maxilla due to different orthodontic appliances: a bone-borne expander, tooth-borne expander, or hybrid-borne expander.…”

Imaging Software Programs for Reliable Mathematical Measurements in Orthodontics

“…An instrument or device could produce the same inaccurate measurement over and over again. This concern is particularly important when planning miniscrew assisted palatal expanders or other miniscrew supported orthodontic devices with a completely digital workflow [ 32 ]. In these cases, the accuracy of the measurements is particularly important, thus allowing the clinician to choose diameter and type of miniscrew as these characteristics have a great influence on the mechanical behavior of the screws [ 33 , 34 ].…”

Telemedicine for a Multidisciplinary Assessment of Orofacial Pain in a Patient Affected by Eagle’s Syndrome: A Clinical Case Report

“…The best treatment for a nerve injury continues to be prevention; a CT scan prior to extraction therapy is the gold standard of care. Aggressively debriding granulation/cystic tissue after a tooth extraction is relevant for the removal of bacteria, inducing angiogenesis and the promotion of proper blood clotting [25,26].…”