Skip to main content

Advertisement

SpringerLink
Log in

Stability of maxillary expansion osteotomy using patient-specific fixation implants without necessitating removable appliances: a retrospective analysis

  • Original Article
  • Published:
Clinical Oral Investigations Aims and scope Submit manuscript

Abstract

Objective

This study aimed to evaluate the long-term stability of surgical maxillary expansion using patient-specific fixation implants (PSFIs) without intraoral retention.

Materials and methods

Fifteen patients who had undergone segmented Le Fort I osteotomy and PSFIs with available preoperative (t0) early (t1) and 1-year follow-up computed tomography (CT) scans (t2) were evaluated. The early and 1-year 3D models were superimposed to transfer the bony landmarks; the distances between each pair of landmarks at the different time points were then measured. The distances between the canines and second molars were also measured directly on the CT scans.

Results

The achieved maxillary expansions ranged from a median of 4.39 (2.00–6.27) mm at the greater palatine foramina to a median of 2.14 (1.56–2 > 83) mm at the canine level of the palatal bone. One year postoperatively, the changes in skeletal diameters ranged from a median of − 0.53 (− 1.65 to 0.41) mm at the greater palatine foramina (p = 0.12) to 0.17 (− 0.09 to 0.32) mm at the canine level of the palatal bone (p = 0.56). Changes in dental arch diameters ranged from a median of − 0.6 (− 2 to 0.00) mm between the second molars to − 1.3 (− 1.8 to − 0.25) mm between the canines (P < 0.05).

Conclusion

This study showed the stability of maxillary expansion osteotomy using PSFIs, even without postoperative intraoral retention.

Clinical relevance

PSFIs are a reliable method for the surgical treatment of transverse maxillary discrepancy. PFSIs are easy-to-use and improve surgical accuracy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. McNamara JA (2000) Maxillary transverse deficiency. Am J Orthod Dentofacial Orthop 117:567–570. https://doi.org/10.1016/s0889-5406(00)70202-2

    Article  PubMed  Google Scholar 

  2. Reyneke JP, Conley RS (2020) Surgical/Orthodontic Correction of Transverse Maxillary Discrepancies. Oral Maxillofac Surg Clin North Am 32:53–69. https://doi.org/10.1016/j.coms.2019.08.007

    Article  PubMed  Google Scholar 

  3. Phillips C, Medland WH, Fields HW et al (1992) Stability of surgical maxillary expansion. Int J Adult Orthodon Orthognath Surg 7:139–146

    PubMed  Google Scholar 

  4. Haas Junior OL, Guijarro-Martínez R, de Sousa Gil AP et al (2019) Hierarchy of surgical stability in orthognathic surgery: overview of systematic reviews. Int J Oral Maxillofac Surg 48:1415–1433. https://doi.org/10.1016/j.ijom.2019.03.003

    Article  PubMed  Google Scholar 

  5. Proffit WR, Turvey TA, Phillips C (1996) Orthognathic surgery: a hierarchy of stability. Int J Adult Orthodon Orthognath Surg 11:191–204

    PubMed  Google Scholar 

  6. Yao W, Bekmezian S, Hardy D et al (2015) Cone-beam computed tomographic comparison of surgically assisted rapid palatal expansion and multipiece Le Fort I osteotomy. J Oral Maxillofac Surg 73:499–508. https://doi.org/10.1016/j.joms.2014.08.024

    Article  PubMed  Google Scholar 

  7. Marchetti C, Pironi M, Bianchi A, Musci A (2009) Surgically assisted rapid palatal expansion vs. segmental Le Fort I osteotomy: transverse stability over a 2-year period. J Craniomaxillofac Surg 37:74–78. https://doi.org/10.1016/j.jcms.2008.08.006

    Article  PubMed  Google Scholar 

  8. Alcalde RE, Bloomquist DS, Joondeph D (2012) Chapter 77 - Maxillary Deficiency: Transverse Plane Discrepancies. In: Bagheri SC, Bell RB, Khan HA (eds) Current Therapy In Oral and Maxillofacial Surgery. W.B. Saunders, Saint Louis, p 640–650

  9. Seeberger R, Gander E, Hoffmann J, Engel M (2015) Surgical management of cross-bites in orthognathic surgery: Surgically assisted rapid maxillary expansion (SARME) versus two-piece maxilla. J Craniomaxillofac Surg 43:1109–1112. https://doi.org/10.1016/j.jcms.2015.05.012

    Article  PubMed  Google Scholar 

  10. Ismail M, Wessel J, Farrell B (2019) Maintenance of Segmental Maxillary Expansion: The Use of Custom, Virtually Designed, and Manufactured Palatal Appliances Without the Use of an Occlusal Splint. J Oral Maxillofac Surg 77:1468.e1-1468.e8. https://doi.org/10.1016/j.joms.2019.03.013

    Article  PubMed  Google Scholar 

  11. Huang GJ, Justus R, Kennedy DB, Kokich VG (1990) Stability of anterior openbite treated with crib therapy. Angle Orthod 60:17–24. https://doi.org/10.1043/0003-3219(1990)060%3c0017:SOAOTW%3e2.0.CO;2. (discussion 25-26)

    Article  PubMed  Google Scholar 

  12. Seemann J, Kundt G, Stahl de Castrillon F (2011) Relationship between occlusal findings and orofacial myofunctional status in primary and mixed dentition: part IV: interrelation between space conditions and orofacial dysfunctions. J Orofac Orthop 72:21–32. https://doi.org/10.1007/s00056-010-0004-1

    Article  PubMed  Google Scholar 

  13. Swennen GRJ, Mollemans W, Schutyser F (2009) Three-dimensional treatment planning of orthognathic surgery in the era of virtual imaging. J Oral Maxillofac Surg 67:2080–2092. https://doi.org/10.1016/j.joms.2009.06.007

    Article  PubMed  Google Scholar 

  14. Stokbro K, Aagaard E, Torkov P et al (2014) Virtual planning in orthognathic surgery. Int J Oral Maxillofac Surg 43:957–965. https://doi.org/10.1016/j.ijom.2014.03.011

    Article  PubMed  Google Scholar 

  15. Metzger MC, Hohlweg-Majert B, Schwarz U et al (2008) Manufacturing splints for orthognathic surgery using a three-dimensional printer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 105:e1-7. https://doi.org/10.1016/j.tripleo.2007.07.040

    Article  PubMed  Google Scholar 

  16. Schouman T, Rouch P, Imholz B et al (2015) Accuracy evaluation of CAD/CAM generated splints in orthognathic surgery: a cadaveric study. Head Face Med 11:24. https://doi.org/10.1186/s13005-015-0082-9

    Article  PubMed  PubMed Central  Google Scholar 

  17. Rückschloß T, Ristow O, Müller M et al (2019) Accuracy of patient-specific implants and additive-manufactured surgical splints in orthognathic surgery - A three-dimensional retrospective study. J Craniomaxillofac Surg 47:847–853. https://doi.org/10.1016/j.jcms.2019.02.011

    Article  PubMed  Google Scholar 

  18. Mazzoni S, Bianchi A, Schiariti G et al (2015) Computer-aided design and computer-aided manufacturing cutting guides and customized titanium plates are useful in upper maxilla waferless repositioning. J Oral Maxillofac Surg 73:701–707. https://doi.org/10.1016/j.joms.2014.10.028

    Article  PubMed  Google Scholar 

  19. Heufelder M, Wilde F, Pietzka S et al (2017) Clinical accuracy of waferless maxillary positioning using customized surgical guides and patient specific osteosynthesis in bimaxillary orthognathic surgery. J Craniomaxillofac Surg 45:1578–1585. https://doi.org/10.1016/j.jcms.2017.06.027

    Article  PubMed  Google Scholar 

  20. Schouman T, Murcier G, Goudot P (2015) The key to accuracy of zygoma repositioning: Suitability of the SynpliciTi customized guide-plates. J Craniomaxillofac Surg 43:1942–1947. https://doi.org/10.1016/j.jcms.2014.12.014

    Article  PubMed  Google Scholar 

  21. Kim H, Cha K-S (2018) Evaluation of the stability of maxillary expansion using cone-beam computed tomography after segmental Le Fort I osteotomy in adult patients with skeletal Class III malocclusion. Korean J Orthod 48:63–70. https://doi.org/10.4041/kjod.2018.48.1.63

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kretschmer WB, Baciut G, Baciut M et al (2011) Transverse stability of 3-piece Le Fort I osteotomies. J Oral Maxillofac Surg 69:861–869. https://doi.org/10.1016/j.joms.2010.05.024

    Article  PubMed  Google Scholar 

  23. Parizotto JOL, Borsato KT, Peixoto AP et al (2020) Can palatal splint improve stability of segmental Le Fort I osteotomies? Orthod Craniofac Res 23:486–492. https://doi.org/10.1111/ocr.12399

    Article  PubMed  Google Scholar 

  24. Pancherz H (1991) The nature of Class II relapse after Herbst appliance treatment: a cephalometric long-term investigation. Am J Orthod Dentofacial Orthop 100:220–233. https://doi.org/10.1016/0889-5406(91)70059-6

    Article  PubMed  Google Scholar 

  25. Hoppenreijs TJ, van der Linden FP, Freihofer HP et al (1998) Stability of transverse maxillary dental arch dimensions following orthodontic-surgical correction of anterior open bites. Int J Adult Orthodon Orthognath Surg 13:7–22

    PubMed  Google Scholar 

  26. Rossetti RA, Cavanagh NJ, Goldberg MH (1993) Transpalatal rigid fixation of the maxillary sagittal osteotomy in Le Fort I orthognathic surgery. J Oral Maxillofac Surg 51:710–711. https://doi.org/10.1016/s0278-2391(10)80279-4

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Guillaume Dubois and Mathieu Charles at Materialise Medical France (Malakoff, France) for providing a Mimics Suite licence and support in performing the measurements. We also thank the orthodontist, Laure Guittard, for her collaboration with this article, especially for the clinical analysis of occlusion stability.

Author information

Authors and Affiliations

  1. Sorbonne Université, APHP, Hôpital Pitié-Salpêtrière, Service de Chirurgie Maxillo-Faciale, 75013, Paris, France

    Philippe Galli, Jean-Philippe Foy, Patrick Goudot & Thomas Schouman

  2. Department of Oral and Maxillofacial Surgery, La Conception University Hospital, Assistance Publique Hôpitaux de Marseille, Aix-Marseille Université, 13005, Marseille, France

    Marc-Kevin Le Roux

  3. Department of Oral and Maxillofacial Surgery, University Hospital, and UFR Medicine, University of Strasbourg, 1, Avenue Molière, 67098, Strasbourg Cedex, France

    Jean-Christophe Lutz

  4. Arts Et Métiers Sciences Et Technologies, Institut de Biomécanique Humaine Georges Charpak (IBHGC), 75013, Paris, France

    Thomas Schouman

Authors
  1. Philippe Galli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jean-Philippe Foy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marc-Kevin Le Roux
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick Goudot
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-Christophe Lutz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thomas Schouman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philippe Galli.

Ethics declarations

Informed consent

Not applicable.

Conflict of interest

This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.

Dr Thomas Schouman is a consultant for Materialise. Dr Thomas Schouman and Pr. Patrick Goudot are co-inventors of the SynpliciTi. The other authors declare no financial disclosures or conflicts of interest.

The Institutional Review Board that approved the study was the Research Ethics Committee of Sorbonne University. (Approval N°: CER-2020–101).

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Galli, P., Foy, JP., Le Roux, MK. et al. Stability of maxillary expansion osteotomy using patient-specific fixation implants without necessitating removable appliances: a retrospective analysis. Clin Oral Invest 27, 3393–3403 (2023). https://doi.org/10.1007/s00784-023-05082-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00784-023-05082-3

Keywords

Search

Navigation