Adult orthodontic treatment using surgically assisted rapid palatal expansion

Method: Twenty-eight adult patients, ages 20-55 years old were referred to the Orthodontic Department, Rambam Campus, Haifa, due to transverse maxillary deficiency. In all patients, orthodontic treatment was planned with preliminary SARPE intervention. After initial orthodontic record collection, a Hyrax-appliance was fabricated and cemented and the patient was referred to the Maxillofacial Surgery Department. The SARPE procedure included bilateral "Inverted L" osteotomy. The vertical cut was performed between the maxillary lateral incisor and the canine roots and the horizontal osteotomy was performed along the maxillary buttress excluding the pterygoid plates. Pre and post-surgical plaster models were analyzed to compare maxillary transverse changes achieved in the canine and first molar in the gingival and occlusal areas.

Result: All SARPE procedures were successfully completed with no adverse effect to the intraoral hard and soft tissues. Long-term clinical follow-up revealed stable results, improved facial esthetics and occlusal relationships. The mean transverse maxillary expansion values measured in the canine area were 3.01mm and 3.4mm for the incisal-tip and gingival-margins, respectively, and in the molar area 5.04mm and 3.68mm for the mesiopalatal-cusp-tip and gingival-margins, respectively. When comparing the pretreatment and postsurgical maxillary width, values were found to be significantly different both in the canine and molar areas.  Nonetheless, no significant differences were found in the canine and molar areas for post-surgical gingival and occlusal values. 

Conclusion: SARPE is an effective and stable preliminary method for severe maxillary transverse discrepancy in adult patients before commencement of adult orthodontic procedures.