Premaxillary Expansion Using the Reverse Quad-Helix Appliance in Cleft Patients

Objectives: The aim of this research is to present a new method for the expansion of the premaxillary area in bilateral and unilateral cleft lip and palate affected patients as a preparatory orthodontic stage for bone graft procedures. Methods: The study group comprised 20 patients aged 5 to 14 years old (mean 8.4 years), presenting with bilateral or unilateral cleft lip and palate from the Orthodontic and Craniofacial Center of the Rambam Health Care Campus, Haifa, Israel. All the patients were scheduled for a bone graft procedure as part of the cleft treatment protocol. In order to gain adequate access for manipulation of the alveolar cleft site during the bone graft procedure, maxillary anterior expansion was performed with a reverse quad helix appliance. Dental casts, before and after maxillary expansion, were obtained for all patients and the upper arch width was assessed in two different maxillary regions, anterior and posterior. The width measurement was carried out in two levels of the maxillary teeth, the occlusal and gingival levels. Results: Using the reverse quad helix for premaxillary expansion resulted in a statistically significant (p≤0.001) anterior expansion which was greater compared to the posterior region in both sets of measurements. Expansion achieved in the anterior region was 9.55±5.18 mm at the occlusal level and 7.30±4.23 mm at the gingival level. However, the expansion achieved in the posterior region was only 5.25±3.10 mm at the occlusal level and 4.52±2.79 mm at the gingival level. Conclusion: The original reverse quad helix is an efficient appliance for premaxillary expansion as a preparatory stage for secondary bone graft procedures in bilateral and unilateral cleft lip and palate affected patients.