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. 2024 Jan-Mar;15(1):27-34.
doi: 10.4103/ccd.ccd_428_23. Epub 2024 Mar 23.

Effect of Different Mini Implant Assisted Rapid Palatal Expansion (MARPE) Designs on Maxillary Protraction in Skeletal Class III malocclusion: An FEM Study

Ashik Suresh  1 , Ajith Vallikat Velath  1 , K Sarika  1 , Rahul Damodaran Prabha  1 , N K Sapna Varma  1
Affiliations

Effect of Different Mini Implant Assisted Rapid Palatal Expansion (MARPE) Designs on Maxillary Protraction in Skeletal Class III malocclusion: An FEM Study

Ashik Suresh et al. Contemp Clin Dent. 2024 Jan-Mar.

Abstract

Background: Four different designs of mini-implant-assisted rapid palatal expansion (MARPE) and protraction in nasomaxillary complex and mid-palatal sutures in late adolescent skeletal Class III malocclusion were compared using a three-dimensional finite element analysis.

Methods: A finite element model of skull and related sutures was constructed using the computed tomography scan of a 16-year-old female patient with skeletal Class III and ANB of -2°. Four appliance designs: Type I: MARPE with palatal force, Type II: MARPE with buccal force, Type III: Hybrid hyrax with palatal force, and Type IV: Hybrid hyrax with buccal force. Protraction vectors were and analyzed using Ansys software (ANSYS 2021 R2). The displacement pattern of the nasomaxillary structures and the stress distribution in the sutures were examined in all four appliance designs.

Results: All the appliance designs resulted in a forward movement of the maxilla, while Type I and III, which used palatal protraction force, caused the greatest forward displacement. In Type I, II, and III, along with forward movement, a clockwise rotation of maxilla was observed, while in Type IV, an anticlockwise rotation of maxilla was observed. Type I, II, and III resulted in higher stress distribution around the superior structures, while Type IV resulted in less stress distribution around the superior structures of maxilla.

Conclusion: The forward displacement was enhanced when palatal plates were used to protract the maxilla. The effective appliance design for skeletal class III with open bite case was Type I, II, and III and Type IV for deep bite cases.

Keywords: Finite element method; maxillary protraction; mini-implant-assisted rapid palatal expansion; skeletal class III.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Segmented three-dimensional model
Figure 2
Figure 2
3D co ordinates: X axis transverse plane, Y axis–sagittal plane and Z axis–vertical plane
Figure 3
Figure 3
Appliance Designs. (a) Mini-implant assisted rapid palatal expansion (MARPE) with palatal hooks (Type I), (b) MARPE with mini plate (Type II), (c) Hybrid hyrax with palatal hooks (Type III), (d) Hybrid hyrax with buccal hooks and arrow represents the point of force application
Figure 4
Figure 4
Anatomical landmarks; 1: frontal process of the maxilla, 2: inferior orbital rim, 3: ANS, 4: Point A, 5: PNS, 6: prosthion, 7: frontal process of the zygoma, 8: maxillary process of the zygoma and 9: temporal process of the zygoma
Figure 5
Figure 5
Circummaxillary sutures (colour coded): Frontomaxillary suture- Blue, Internasal suture -Yellow , Zygomaticomaxillary suture -Red, Zygomaticofrontal sutures -Green, Zygomaticotemporal suture – Pink, Pterygomaxillary suture -Purple, Midpalatal sutures - Brown: Midpalatal sutures
Figure 6
Figure 6
Three-dimensional finite element method of the craniomaxillary complex showing displacement; (a) Type I, (b) Type II, (c) Type III, (d) Type IV
Figure 7
Figure 7
Three-dimensional finite element method of the craniofacial sutures showing stress distribution. (a) Type I, (b) Type II, (c) Type III and (d) Type IV
Figure 8
Figure 8
Superimposition. Before: Opaque, After: Variety of colors. (a) Type I, (b) Type II, (c) Type III and (d) Type IV
See this image and copyright information in PMC

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