“Comparative evaluation of stress distribution, displacement pattern and buccolingual angulation between four different bone-borne rapid palatal expanders in bilateral cleft lip and palate patients:A three-dimensional Finite Element Analysis”.
Keywords:
N\AAbstract
Background: Bilateral cleft lip and palate (BCLP) patients commonly present with maxillary transverse deficiency requiring palatal expansion. Conventional tooth-borne expanders often produce undesirable dentoalveolar effects such as buccal tipping and periodontal stress. Bone-borne rapid palatal expanders have been developed to enhance skeletal expansion while minimizing these adverse effects. However, limited evidence is available comparing the biomechanical performance of different bone-borne and bone and tooth borne rapid palatal expander designs in terms of stress distribution, displacement pattern, and buccolingual angulation in BCLP patients using three-dimensional finite element analysis (FEA).
Aim: To comparatively evaluate stress distribution, displacement pattern, and buccolingual angulation among four different bone-borne rapid palatal expanders in bilateral cleft lip and palate patients using three-dimensional finite element analysis.
Materials and Methods: A three-dimensional finite element model of the maxilla of a bilateral cleft lip and palate patient was constructed from cone-beam computed tomography (CBCT) data. Four rapid palatal expansion designs—Hybrid Hyrax, MARPE No-DS, MARPE DS with three miniscrews, and MARPE DS with four miniscrews—were virtually adapted to the model. Standardized expansion forces were applied under identical simulation conditions, and von Mises stress distribution, displacement pattern, and buccolingual angulation were analyzed.
Results: All four expansion systems demonstrated distinct biomechanical responses. The Hybrid Hyrax appliance produced the highest stress concentration, displacement, and buccolingual angulation, indicating predominantly dentoalveolar effects. MARPE No-DS exhibited the lowest stress, negligible displacement, and no measurable tooth angulation, suggesting predominantly skeletal expansion. Both MARPE DS designs produced intermediate responses, with the four miniscrew configuration demonstrating more uniform stress distribution, controlled displacement, and symmetrical tooth angulation than the three-miniscrew design, indicating superior biomechanical stability.
Conclusion: The biomechanical performance of rapid palatal expanders varied according to the anchorage design. Bone-borne expanders, particularly the MARPE DS with four miniscrews, provided a more favourable balance between skeletal expansion and controlled dentoalveolar effects compared with the Hybrid Hyrax appliance. Three-dimensional finite element analysis proved to be a valuable method for evaluating appliance biomechanics and may assist clinicians in selecting the most appropriate expander for patients with bilateral cleft lip and palate..
Downloads
References
1. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet. 2009;374(9703):1773-85.
2- Semb G. A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP team.The Cleft Palate Journal. 1991;28(1):1-21.
3- Bishara SE, Staley RN. Maxillary expansion: clinical implications. Am J Orthod Dentofacial Orthop. 1987;91(1):3-14.
4- Lee KJ, Park YC, Park JY, Hwang WS. Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism. Am J Orthod Dentofacial Orthop. 2010;137(6):830-9.
5- Cantarella D, Dominguez-Mompell R, Moschik C, Mallya SM, Pan HC, Alkahtani MR, Elkenawy I, Moon W. Midfacial changes in the coronal plane induced by microimplant-supported skeletal expander, studied with cone-beam computed tomography images. Am J Orthod Dentofacial Orthop. 2018;154(3):337-345.
6- Garib DG, Henriques JF, Janson G, de Freitas MR, Fernandes AY. Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: a computed tomography evaluation. Am J Orthod Dentofacial Orthop. 2006 ;129(6):749-58.
7- Cattaneo PM, Dalstra M, Melsen B. Strains in periodontal ligament and alveolar bone associated with orthodontic tooth movement analyzed by finite element. Orthod Craniofac Res. 2009;12(2):120-8.
8- Mathew A, Nagachandran KS, Vijayalakshmi D. Stress and displacement pattern evaluation using two different palatal expanders in unilateral cleft lip and palate: a three-dimensional finite element analysis. Prog Orthod. 2016;17(1):38.
9- Sabri R. Cleft lip and palate management with maxillary expansion and space opening for a single tooth implant. American Journal of Orthodontics and Dentofacial Orthopedics. 2000;117(2):148-55.
10- Lagravere MO, Major PW, Flores-Mir C. Long-term skeletal changes with rapid maxillary expansion. The Angle Orthodontist. 2005;75(6):1046-52.
11- Holberg C, Steinhäuser S, Rudzki-Janson I. Rapid maxillary expansion in adults: cranial stress reduction depending on the extent of surgery. The European Journal of Orthodontics. 2007;29(1):31-6.
12- Provatidis CG, Georgiopoulos B, Kotinas AA, McDonald JP. Evaluation of craniofacial effects during rapid maxillary expansion through combined in vivo/in vitro and finite element studies. The European Journal of Orthodontics. 2008;30(5):437-48.
13- Vasant MR, Menon S, Kannan S. Maxillary expansion in cleft lip and palate using quad helix and rapid palatal expansion screw. Medical Journal Armed Forces India. 2009 ;65(2):150-3.
14- Kartalian A, Gohl E, Adamian M, Enciso R. Cone-beam computerized tomography evaluation of the maxillary dentoskeletal complex after rapid palatal expansion. American journal of orthodontics and dentofacial orthopedics. 2010;138(4):486-92.
15- Ghoneima A, Abdel-Fattah E, Hartsfield J, El-Bedwehi A, Kamel A, Kula K. Effects of rapid maxillary expansion on the cranial and circummaxillary sutures. American Journal of Orthodontics and Dentofacial Orthopedics. 2011;140(4):510-9.
16- Brunetto M, Andriani Jda S, Ribeiro GL, Locks A, Correa M, Correa LR. Three-dimensional assessment of buccal alveolar bone after rapid and slow maxillary expansion: a clinical trial study. Am J Orthod Dentofacial Orthop. 2013;143(5):633-44.
17- Ani S, Shah V, Parashar A. Arch Expansion in Cleft Lip and Palate Patients. Indian Journal of Fundamental and Applied Life Sciences. 2013;3(2):25–28.
18- Figueiredo DS, Bartolomeo FU, Romualdo CR, Palomo JM, Horta MC, Andrade Jr I, Oliveira DD. Dentoskeletal effects of 3 maxillary expanders in patients with clefts: a cone-beam computed tomography study. American Journal of Orthodontics and Dentofacial Orthopedics. 2014;146(1):73-81
19- Lin L, Ahn HW, Kim SJ, Moon SC, Kim SH, Nelson G. Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence. The Angle Orthodontist. 2015;85(2):253-62.
20- Moon W, Wu KW, MacGinnis M, Sung J, Chu H, Youssef G, Machado A. The efficacy of maxillary protraction protocols with the micro-implant-assisted rapid palatal expander (MARPE) and the novel N2 mini-implant—a finite element study. Progress in orthodontics. 2015;16(1):16.
21- Sumita Jain DS, Jain NK. Maxillary expansion in cleft lip and palate cases-a review. International Journal. 2015;3(9):1455-61.
22- Lee H, Nguyen A, Hong C, Hoang P, Pham J, Ting K. Biomechanical effects of maxillary expansion on a patient with cleft palate: A finite element analysis. American journal of orthodontics and dentofacial orthopedics. 2016;150(2):313-23.
23- Copello FM, Brunetto DP, Elias CN, Pithon MM, Coqueiro RS, Castro ACR, Sant'anna EF. Miniscrew-assisted rapid palatal expansion (MARPE): how to achieve greater stability. In vitro study. Dental Press J Orthod. 2021;26(1):e211967.
24- Gandedkar, N.H., Liou, E.JW. The immediate effect of alternate rapid maxillary expansions and constrictions on the alveolus: a retrospective cone beam computed tomography study. Prog Orthod. 19, 40 (2018).
25- Torres A, AlYazeedy I, Yen S. A Programmable Expander for Patients With Cleft Lip and Palate. The Cleft Palate Craniofacial Journal. 2019;56(6):837-844.
26- Fayeez, Zaheeruddin et al. “Anterior Maxillary Expansion using Modified Reverse Quad Helix Appliance in Cleft Palate Patient.” (2021).
27- Luyten J, De Roo NM, Christiaens J, Van Overberghe L, Temmerman L, De Pauw GA. Rapid maxillary expansion vs slow maxillary expansion in patients with cleft lip and/or palate: a systematic review and meta-analysis. The Angle Orthodontist. 2023;93(1):95-103.
28- Barillas AP, Michelogiannakis D, Rossouw PE, Javed F. Maxillary expansion in grafted alveolar arches in patients with cleft lip and palate: A literature review. Surgery in Practice and Science. 2021;5:100034.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
