a expansão rápida da maxila (ERM) é a terapia de escolha para a correção da dimensão transversa esquelética em crianças e adolescentes, associando-se efeitos ortopédicos e dentários. Com a finalidade de prevenir os efeitos dentoalveolares indesejáveis e otimizar o potencial de expansão esquelética em indivíduos com estágios avançados de maturação esquelética, a técnica de expansão rápida da maxila assistida por mini-implantes (MARPE) foi proposta por Lee e colaboradores em 2010.

Objetivo:

o presente estudo apresenta um protocolo sistematizado para seleção de mini-implantes indicados para a MARPE, mediante avaliação de imagens de tomografia computadorizada de feixe cônico (TCFC). Variáveis relacionadas à espessura de tecido ósseo e tecido mole nas regiões de interesse do palato, bem como em relação ao anel de fixação dos mini-implantes do parafuso expansor, são analisadas e discutidas para proporcionar melhor desempenho na prática clínica.

Palavras-chave:
Técnica de expansão palatina; Procedimentos de ancoragem esquelética; Má oclusão; Atresia transversa maxilar

Autoria

Lincoln Issamu Nojima

Universidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil).Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilUniversidade Federal do Rio de Janeiro, Department of Pediatric Dentistry and Orthodontics (Rio de Janeiro/RJ, Brazil).

Matilde da Cunha Gonçalves Nojima

Amanda Carneiro da Cunha

Natan Oliveira Guss

Universidade Federal do Rio de Janeiro, Post-graduation Program in Orthodontics (Rio de Janeiro/RJ, Brazil).Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilUniversidade Federal do Rio de Janeiro, Post-graduation Program in Orthodontics (Rio de Janeiro/RJ, Brazil).

Eduardo Franzotti Sant’Anna

Contact address:
Lincoln Issamu Nojima Av Professor Rodolpho Paulo Rocco, 325 - Ilha do Fundão Rio de Janeiro - RJ - Brasil - CEP: 21941-617 E-mail: linojima@gmail.com

Author contributions

Conceived and designed the study: LN. Data acquisition, analysis or interpretation: LN, ACC, NGO. Writing the article: LN, MCGN, ACC, NGO. Critical revision of the article: MCGN, NGO, EFS. Final approval of the article: LN. Obtained funding: LN. Overall responsibility: LN.

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Figuras

Figuras (8)

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Figure 1
A, B) Clinical photographs in occlusal view, before and after expansion, respectively. C, D) Mesial right and mesial left miniscrews used as anchorage for MARPE, after its removal from the oral cavity.

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Figure 2
A) Initial dental cast. B) Delineation of dotted line referring to the midpalatal suture. C) Positioning of expanding screw coinciding with the midpalatal suture line. D) Delineation of reference lines (in blue), transverse to the midpalatal suture, passing through the center of miniscrews fixation rings mesial and distal to the expanding screw.

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Figure 3
CBCT images illustrating the maxilla in multiplanar sections. A) Sagittal section. B) Coronal section. The axial section should coincide with the occlusal plane, delineated by the cusp tips of molars and incisal edges of maxillary central incisors.

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Figure 4
A) Dental cast illustrating the delineation of reference line (in blue) passing through the miniscrews fixation rings at the mesial region of the expanding screw, extending to the second premolars. B) CBCT images: on the axial section with the reference line (in blue), and on the coronal section evidencing the quantity of bone equidistant to the midpalatal suture, corresponding to the position of the reference line delineated on the axial section (in blue). C) Dental cast with delineation of reference line (in blue), passing through the miniscrews fixation rings at the distal region of the expanding screw and extending to the molars. D) CBCT images: on the axial section, with the reference line (in blue), and on the coronal section evidencing the quantity of bone equidistant to the midpalatal suture, corresponding to the level of the reference line delineated on the axial section (in blue). E) Measurement of width between the miniscrews fixation rings of the expanding screw, assessed with a caliper. F) CBCT images illustrating the measurement of bone and soft tissue height, on the coronal section corresponding to the distal region of the expanding screw.

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Figure 5
Measurement of height of fixation rings of anterior (A) and posterior miniscrews (B); and between them and the palatal surface assessed on the dental cast using a periodontal probe with millimeter marks.

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Figure 6
CBCT image on the coronal section at the distal region of the expanding screw, illustrating the bicortical insertion of miniscrews.

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Figure 7
A, B) CBCT images on the axial section, before and after MARPE. Red arrows indicate the opening of the midpalatal suture. C, D) Clinical photographs, in occlusal view, before and after MARPE, respectively.

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Figure 8
CBCT images. A) Axial section. B) Coronal section at the region of dotted lines (in red, in A). C) Sagittal section at the level of dotted lines (in green, in A), evidencing scarce bone tissue for anchorage of miniscrews in MARPE.

Figure 1 A, B) Clinical photographs in occlusal view, before and after expansion, respectively. C, D) Mesial right and mesial left miniscrews used as anchorage for MARPE, after its removal from the oral cavity.

Figure 2 A) Initial dental cast. B) Delineation of dotted line referring to the midpalatal suture. C) Positioning of expanding screw coinciding with the midpalatal suture line. D) Delineation of reference lines (in blue), transverse to the midpalatal suture, passing through the center of miniscrews fixation rings mesial and distal to the expanding screw.

Figure 3 CBCT images illustrating the maxilla in multiplanar sections. A) Sagittal section. B) Coronal section. The axial section should coincide with the occlusal plane, delineated by the cusp tips of molars and incisal edges of maxillary central incisors.

Figure 4 A) Dental cast illustrating the delineation of reference line (in blue) passing through the miniscrews fixation rings at the mesial region of the expanding screw, extending to the second premolars. B) CBCT images: on the axial section with the reference line (in blue), and on the coronal section evidencing the quantity of bone equidistant to the midpalatal suture, corresponding to the position of the reference line delineated on the axial section (in blue). C) Dental cast with delineation of reference line (in blue), passing through the miniscrews fixation rings at the distal region of the expanding screw and extending to the molars. D) CBCT images: on the axial section, with the reference line (in blue), and on the coronal section evidencing the quantity of bone equidistant to the midpalatal suture, corresponding to the level of the reference line delineated on the axial section (in blue). E) Measurement of width between the miniscrews fixation rings of the expanding screw, assessed with a caliper. F) CBCT images illustrating the measurement of bone and soft tissue height, on the coronal section corresponding to the distal region of the expanding screw.

Figure 5 Measurement of height of fixation rings of anterior (A) and posterior miniscrews (B); and between them and the palatal surface assessed on the dental cast using a periodontal probe with millimeter marks.

Figure 6 CBCT image on the coronal section at the distal region of the expanding screw, illustrating the bicortical insertion of miniscrews.

Figure 7 A, B) CBCT images on the axial section, before and after MARPE. Red arrows indicate the opening of the midpalatal suture. C, D) Clinical photographs, in occlusal view, before and after MARPE, respectively.

Figure 8 CBCT images. A) Axial section. B) Coronal section at the region of dotted lines (in red, in A). C) Sagittal section at the level of dotted lines (in green, in A), evidencing scarce bone tissue for anchorage of miniscrews in MARPE.

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[1] Contact address:
Lincoln Issamu Nojima Av Professor Rodolpho Paulo Rocco, 325 - Ilha do Fundão Rio de Janeiro - RJ - Brasil - CEP: 21941-617 E-mail: linojima@gmail.com