Korean J Orthod.  2024 Nov;54(6):346-358. 10.4041/kjod24.180.

Effect of bone-borne maxillary skeletal expanders on cranial and circummaxillary sutures: A cone-beam computed tomography study

• Xu B
• Park JJ
• Bai J
• Kim SH

• KMID: 2561597
• DOI: http://doi.org/10.4041/kjod24.180

Abstract

Objective
Miniscrew-assisted maxillary expansion devices are frequently used for patients with calcified midpalatal sutures. This study aimed to evaluate the effects of two bone-borne maxillary expansion appliances on the cranial and circummaxillary sutures by comparing cone-beam computed tomography (CBCT) images before and after transverse maxillary expansion. Methods: A total of 81 patients (women = 58, men = 23) were treated with either a C-expander (n = 44) or an ATOZ expander (n = 37). CBCT images were obtained before (T0) and after (T1) maxillary expansion, and the widths of 10 circummaxillary sutures were measured in the sagittal, coronal, and axial planes. The Wilcoxon signed-rank test was used to compare the changes in suture width between the C-expander and ATOZ groups, and statistical significance was set at P < 0.05.
Results
The frontonasal, frontomaxillary, pterygomaxillary, nasomaxillary, internasal, intermaxillary, and midpalatal suture widths increased significantly after maxillary expansion in both the ATOZ and C-expander groups (both P < 0.05). The frontozygomatic, zygomaticomaxillary, and temporozygomatic suture widths decreased in the C-expander group (P < 0.05), whereas the frontozygomatic suture width increased significantly in the ATOZ group (P < 0.05). The width changes of the frontozygomatic, zygomaticomaxillary, temporozygomatic, pterygomaxillary, internasal, intermaxillary, and midpalatal sutures differed significantly between the two groups (P < 0.05).
Conclusions
Both the C- and ATOZ expanders affected the suture width in the naso-maxillozygomatic region. The C-expander decreased the circum-zygomatic suture widths, whereas the ATOZ expander widened the frontozygomatic suture with no effect on other circummaxillary sutures.

Keyword

Computed tomography; Expansion; C-expander; ATOZ expander

Figure

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  Figure 1 Representative pre- and post-treatment occlusal images of a 16 year-old girl treated with a tissue bone-borne type C-expander showing the treatment stages of C-expander: A, After placement of six 1.6-mm diameter, 8-mm length miniscrews, B, device placement, C, post-expansion, D, occlusal radiograph after expansion.

• 

  Figure 2 Schematic illustration of the ATOZ expander. A, The ATOZ expander is composed of the base, a hexagonal nut, screw holes formed in the base, and a screw hole for the wire arm. B, Comparison of the sizes of the tooth-bone hybrid MARPE (MSE2, Biomaterials Korea Inc., Seoul, Korea) and ATOZ (MK Meditech Inc., Seongnam, Korea). C, MSE2 applied to a model with a narrow palate. D, ATOZ applied to the same model as in (C). Both devices facilitate expansion up to 8 mm.

• 

  Figure 3 Graph showing the amount of expansion achieved with the ATOZ. Initially, the expansion occurs rapidly owing to the effective expansion force; however, expansion gradually decreases over time. At this stage, treatment can be completed quickly with rapid expansion, or the expansion can be slowed to keep the circum-maxillary sutures continuously activated, depending on the treatment goals. *The ATOZ can withstand up to 50 kgf of compression force without permanent deformation and can easily revert to its original shape. This unique capability is due to its distinctive 4-link structure, similar to that of a beam spring, allows for the continuous dissipation of heavy orthopedic forces (ranging from 7–12 kgf) for > 4 weeks or until the next appointment.

• 

  Figure 4 A, B, ATOZ placement using a thermoplastic installation guide. After administering lidocaine local anesthesia, the installation guide is placed on the palate and a motor-driven screwdriver is used to insert the anchoring miniscrews. After inserting the four anchoring miniscrews, the ATOZ achieves initial stability. The installation guide is removed, and the remaining miniscrews are inserted. C, D, Intraoral photographs taken before and after key activation, respectively.

• 

  Figure 5 Representative pre- and post-treatment images of a 15-year-old girl treated with pure bone-borne type ATOZ expander. Intraoral photographs and cone-beam computed tomography images showing the treatment stages of the pure bone-borne ATOZ expander: A–C, Expansion started; D–F, After 8 mm expansion.

• 

  Figure 6 Schematic diagram showing the 10 circummaxillary sutures measured in this study: A, Coronal plane; B, Sagittal plane; C, Axial plane.

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  Figure 7 Orientation of the radiographs in the coronal, sagittal, and axial planes.

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  Figure 8 Sutures measured in the sagittal plane. A, B, Frontonasal suture; C, D, Frontomaxillary suture; E, F, Pterygomaxillary suture. Red arrow, actual suture measured.

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  Figure 9 Sutures measured in the coronal plane. A, B, Frontozygomatic suture; C, D, Zygomaticomaxillary suture; E, F, Temporozygomatic suture.

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  Figure 10 Sutures measured in the axial plane. A, B, Internasal suture; C, D, Nasomaxillary suture; E, F, Intermaxillary (IM), midpalatal canine (MPC), midpalatal premolar (MPP), midpalatal molar (MPM) and midpalatal posterior nasal spine (MPPNS) sutures.

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  Figure 11 Schematic illustrations of tooth displacement following moderate orthodontic force application (A) and midpalatal suture (MPS) and circummaxillary suture (CMS) separation after ATOZ expander activation (B). Adapted from the book of Graber et al. (Orthodontics: current principles and techniques. 6th ed. St. Louis: Elsevier; 2017. Chapter 4, Figure 4-49 with original copyright holder’s permission.32

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