Digital Planning and Manufacturing of Maxillary Skeletal Expander for Patients with Thin Palatal Bone

Abstract

The miniscrew-assisted rapid palatal expansion approach has given new opportunities for the treatment of maxilla transverse deficiency by providing an alternative to the surgical approach for adult patients. However, the presence of a thin palatal bone can compromise the success of such approach. Recently, the digital planning of the miniscrew-assisted appliances has offered unique advantages in terms of safety and accuracy of the overall process. The aim of this study is to describe the digital planning and MSE fabrication with cad-cam technology using 6 mini-screws in cases with a palatal bone thickness of less than 2.5 mm.

A Digital Workflow for Mini-Implant–Assisted Rapid Palatal Expander Construction

“…The MSE appliance should be positioned in the posterior palate between the right and left zygomatic buttress bones. 29,31 However, the posterior palate has a relatively thin bone, and the mini-implants must be placed in a secure area, immediately lateral to the midpalatal suture where the bone has a higher density and greater thickness. 25 The min-implants must be engaged bicortically to ensure the stability.…”

“…To identify the best position for both parts, several digital work ows have been proposed by previous researchers using various expander designs. [29][30][31]41 Often these systems require a two-step process: mini-implant insertion by a digitally produced stent and retro tting of MARPE onto the mini-implants by digital processing. The surgical stent is not required for MSE since the appliance comes with guiding slots for the mini-implants, and the appliance itself serves as a surgical guide, eliminating the retro tting of the appliance to the mini-implants.…”

“…24,28 To tackle this problem, recent publications have introduced digitally aided design processes. [29][30][31] Cantarella et al used commercially available software to establish an optimal MSE position rst and then printed out the position guide for soldering on a stone model. Giudice et al used Dolphin software to import a negative MSE template to position the expander and the mini-screws, then printed the maxillary model combined with a negative MSE template for soldering.…”

CAD/CAM design and 3D printing of a personalised rapid palatal expander for maxillary transverse deficiency

“…With the rapid advent of digital workflows and three dimensional imaging, including Cone-Beam Computed Tomography (CBCT), customisation of RME appliances has become possible, offering means to avoid the pitfalls of prefabricated expanders, with improved safety, accuracy, and treatment outcomes. 4,5 Digital workflow-based customised MARPE appliances have been successfully applied in cases with thin palatal bone. 5 Herein, we report a protocol for the construction of a novel personalised MARPE (pMARPE) using Computer-Aided Design/Computer-Aided manufacturing (CAD/CAM) and 3D printing techniques.…”

“…4,5 Digital workflow-based customised MARPE appliances have been successfully applied in cases with thin palatal bone. 5 Herein, we report a protocol for the construction of a novel personalised MARPE (pMARPE) using Computer-Aided Design/Computer-Aided manufacturing (CAD/CAM) and 3D printing techniques. In brief, CBCT imaging was aligned with a digitised model of the upper maxilla, making it possible to measure the palatal bone thickness and plan the optimal position and direction of the mini-implant.…”