Biomechanics of Rapid Maxillary Expansion: In Cleft and Non-cleft Patients

  • Dr Pawan Gautam, India

Rapid Maxillary Expansion (RME) is commonly used as part of sequential treatment for cleft palate (CLP) patients for the correction of collapsed cleft segments and to ensure normal transverse relationship between the maxilla and the mandible in non-cleft patients. Clinical studies evaluating dentoskeletal effects have provided valuable information. However, most of them have been limited in precise evaluation of the biomechanical effect of orthopedic forces on the internal bony structures, including the sutures, of the craniofacial complex. Finite Element Method (FEM) is commonly used to elucidate the biomechanical components such as displacements, strains, and stresses induced in the living structures from various external forces. As evaluated by FEM, a typical wedge shaped opening in antero-posterior as well as supero-inferior direction is observed with RME in non-cleft patients. RME causes downward and forward displacement of the maxilla, and can contribute to correction of mild Class III malocclusions. The downward and backward rotation of the maxilla could be a concern in patients with excessive lower anterior facial height, because of its potential to further add to the vertical discrepancy. With palatal defect and anatomical deformity of maxillary bone in the CLP patient, it could be expected that the interaction mechanism between the expansive force and resistance to expansion would be different in these patients. The typical wedge shaped opening following RME, observed in non-cleft patients, is not seen in cleft patients. The RME leads to asymmetric displacement and stress distribution in the two maxillary halves. It can be suggested that the patients with cleft anomaly respond differently to the expansion therapy, hence clinicians should consider a need for customization of expansion therapy for clefts patients depending on the age, type of cleft and desired area of expansion. High stresses along the deep structures and various sutures of the craniofacial skeleton signify the role of circum-maxillary sutural system in skeletal response following RME in both cleft and non-cleft patients.