Procedure using CAD/CAM-manufactured insertion guides for purely mini-implant-borne rapid maxillary expanders

Abstract

With traditional rapid palatal expansion (RPE), orthopaedic forces are transmitted to the skeletal structures via the anchor teeth potentially leading to several unwanted dental side effects. To prevent these issues, tooth-bone-borne or purely bone-borne expanders were introduced using mini-implants in the palate. In this paper, the digitally planned Quadexpander is described which permits palatal expansion with only skeletal anchorage. The use of virtual insertion planning allows for insertion in areas of ideal bone, while avoiding roots and vital structures as well as the possibility of insertion into sites which would otherwise not be considered usable. A second advantage of digital planning is that mini-implants and the expander can be inserted in just one appointment.

Keywords: Mini-implants; Quadexpander; Rapid maxillary expansion; Skeletal anchorage; Temporary anchorage device.

Fig. 1

Transversal maxillary deficiency of an 18-year-old patient (case 1) Transversale maxilläre Hypoplasie bei einem 18-jährigen Patienten (Fall 1)

Fig. 2

After superimposition of the digitized model and the cone-beam computed tomographic (CBCT) image, the optimal anterior and posterior positions of the mini-implants are virtually planned (Easy Driver V 2.0.2019, Uniontech, Parma, Italy) (case 1) Nach der Überlagerung des digitalisierten Modells und der DVT-Aufnahme wird die optimale anteriore und posteriore Position der Mini-Implantate virtuell geplant (Easy Driver V 2.0.2019, Uniontech, Parma, Italien) (Fall 1)

Fig. 3

Insertion guide (Seido-Systems, Kortrijk, Belgium; Stratasys LTD, Eden Prairie, MN, USA) for case 1: insertion site, depth and angulation are predetermined Insertionsguide (Seido-Systems, Kortrijk, Belgien; Stratasys LTD, Eden Prairie, MN, USA) für Fall 1: Insertionsregion, -tiefe und -winkel sind vorgegeben

Fig. 4

Clinical procedure of case 1: a Quadexpander with a Power Screw (Tiger Dental, Bregenz, Austria), b temporary anchorage devices (Benefit System, PSM, Gunningen, Germany) after insertion. c,d Before and after expansion Klinischer Verlauf, Fall 1: a Quadexpander mit einer PowerScrew (Tiger Dental, Bregenz, Österreich), b temporäre Verankerungen (Benefit System, PSM, Gunningen, Deutschland) nach dem Einsetzen. c,d Vor und nach Erweiterung

Fig. 5

Transversal maxillary deficiency in a 22-year-old patient (case 2) Transversale maxilläre Hypoplasie bei einem 22-jährigen Patienten (Fall 2)

Fig. 6

Virtual planning (Easy Driver V 2.0.2019, Uniontech, Parma, Italy) of optimal insertion sites for palatal temporary anchorage devices in the anterior (a–d) and posterior (c–e) palate (case 2) Virtuelle Planung (Easy Driver V 2.0.2019, Uniontech, Parma, Italien) der optimalen Insertionsstellen für die temporären palatinalen Verankerungen im anterioren (a–d) und posterioren (e) Gaumen (Fall 2)

Fig. 7

Insertion guide (Seido-Systems, Kortrijk, Belgium; Stratasys LTD, Eden Prairie, MN, USA) for case 2: insertion site, depth and angulation are predetermined Insertionsguide (Seido-Systems, Kortrijk, Belgien; Stratasys LTD, Eden Prairie, MN, USA) für Fall 2: Insertionsstelle, -tiefe und -winkel sind vorgegeben

Fig. 8

Clinical follow-ups of case 2 (22-year-old man), after insertion of four palatal temporary anchorage devices (a), expander in situ (b), after expansion with the first nut (c), after continuing of the expansion with the bigger nut (d) Klinische Nachuntersuchungen von Fall 2 (22-jähriger Mann), nach Einsetzen von 4 temporären palatinalen Verankerungen (a), Expander in situ (b), nach Expansion mit der ersten Nut (c), nach Fortsetzung der Expansion mit der größeren Nut (d)