A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion

Daniele Cantarella,1 Gianpaolo Savio,2 Luca Grigolato,2 Paolo Zanata,3 Chiara Berveglieri,4 Antonino Lo Giudice,5,6 Gaetano Isola,5 Massimo Del Fabbro,1 Won Moon7 1Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; 2Department of Civil, Environmental and Archi...

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Autores principales:	Cantarella D, Savio G, Grigolato L, Zanata P, Berveglieri C, Lo Giudice A, Isola G, Del Fabbro M, Moon W
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	miniscrew-assisted rapid palatal expansion (marpe) cone beam computed tomography (cbct) mse digital planning and workflow virtual planning temporary anchorage device (tad) cephalometrics-based digital planning (cbdp) Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/42290f18389941ebb05edb735fbf34ad
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id	oai:doaj.org-article:42290f18389941ebb05edb735fbf34ad
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	miniscrew-assisted rapid palatal expansion (marpe) cone beam computed tomography (cbct) mse digital planning and workflow virtual planning temporary anchorage device (tad) cephalometrics-based digital planning (cbdp) Medical technology R855-855.5
spellingShingle	miniscrew-assisted rapid palatal expansion (marpe) cone beam computed tomography (cbct) mse digital planning and workflow virtual planning temporary anchorage device (tad) cephalometrics-based digital planning (cbdp) Medical technology R855-855.5 Cantarella D Savio G Grigolato L Zanata P Berveglieri C Lo Giudice A Isola G Del Fabbro M Moon W A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion
description	Daniele Cantarella,1 Gianpaolo Savio,2 Luca Grigolato,2 Paolo Zanata,3 Chiara Berveglieri,4 Antonino Lo Giudice,5,6 Gaetano Isola,5 Massimo Del Fabbro,1 Won Moon7 1Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; 2Department of Civil, Environmental and Architectural Engineering ICEA, University of Padova, Padova, Italy; 3Private Practice, Castelfranco Veneto, Italy; 4Private Practice of Orthodontics, Bondeno, Italy; 5Department of General Surgery and Surgical-Medical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Catania, Italy; 6Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, University of Messina, Messina, Italy; 7Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, Los Angeles, CA, USACorrespondence: Daniele CantarellaDepartment of Biomedical, Surgical and Dental Sciences, University of Milan, Via Commenda 10, Milan, ItalyEmail danielecant@hotmail.comIntroduction: Miniscrew-assisted rapid palatal expansion (MARPE) appliances utilize the skeletal anchorage to expand the maxilla. One type of MARPE device is the Maxillary Skeletal Expander (MSE), which presents four micro-implants with bicortical engagement of the palatal vault and nasal floor. MSE positioning is traditionally planned using dental stone models and 2D headfilms. This approach presents some critical issues, such as the inability to identify the MSE position relative to skeletal structures, and the potential risk of damaging anatomical structures.Methods: A novel methodology has been developed to plan MSE position using the digital model of dental arches and cone-beam computed tomography (CBCT). A virtual model of MSE appliance with the four micro-implants was created. After virtual planning, a positioning guide is virtually designed, 3D printed, and utilized to model and weld the MSE supporting arms to the molar bands. The expansion device is then cemented in the patient oral cavity and micro-implants inserted. A clinical case of a 12.9-year-old female patient presenting a Class III malocclusion with transverse and sagittal maxillary deficiency is reported.Results: The midpalatal suture was opened with a split of 3.06 mm and 2.8 mm at the anterior and posterior nasal spine, respectively. After facemask therapy, the sagittal skeletal relationship was improved, as shown by the increase in ANB, A-Na perpendicular and Wits cephalometric parameters, and the mandibular plane rotated 1.6° clockwise.Conclusion: The proposed digital methodology represents an advancement in the planning of MSE positioning, compared to the traditional approach. By evaluating the bone morphology of the palate and midface on patient CBCT, the placement of MSE is improved regarding the biomechanics of maxillary expansion and the bone thickness at micro-implants insertion sites. In the present case report, the digital planning was associated with a positive outcome of maxillary expansion and protraction in safety conditions.Keywords: miniscrew-assisted rapid palatal expansion, MARPE, CBCT, MSE, virtual planning, cephalometrics-based digital planning, CBDP, workflow, TAD
format	article
author	Cantarella D Savio G Grigolato L Zanata P Berveglieri C Lo Giudice A Isola G Del Fabbro M Moon W
author_facet	Cantarella D Savio G Grigolato L Zanata P Berveglieri C Lo Giudice A Isola G Del Fabbro M Moon W
author_sort	Cantarella D
title	A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion
title_short	A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion
title_full	A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion
title_fullStr	A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion
title_full_unstemmed	A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion
title_sort	new methodology for the digital planning of micro-implant-supported maxillary skeletal expansion
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/42290f18389941ebb05edb735fbf34ad
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spelling	oai:doaj.org-article:42290f18389941ebb05edb735fbf34ad2021-12-02T09:43:13ZA New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion1179-1470https://doaj.org/article/42290f18389941ebb05edb735fbf34ad2020-03-01T00:00:00Zhttps://www.dovepress.com/a-new-methodology-for-the-digital-planning-of-micro-implant-supported--peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470Daniele Cantarella,1 Gianpaolo Savio,2 Luca Grigolato,2 Paolo Zanata,3 Chiara Berveglieri,4 Antonino Lo Giudice,5,6 Gaetano Isola,5 Massimo Del Fabbro,1 Won Moon7 1Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy; 2Department of Civil, Environmental and Architectural Engineering ICEA, University of Padova, Padova, Italy; 3Private Practice, Castelfranco Veneto, Italy; 4Private Practice of Orthodontics, Bondeno, Italy; 5Department of General Surgery and Surgical-Medical Specialties, Section of Orthodontics, School of Dentistry, University of Catania, Catania, Italy; 6Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Orthodontics, University of Messina, Messina, Italy; 7Division of Growth and Development, Section of Orthodontics, School of Dentistry, Center for Health Science, University of California, Los Angeles, Los Angeles, CA, USACorrespondence: Daniele CantarellaDepartment of Biomedical, Surgical and Dental Sciences, University of Milan, Via Commenda 10, Milan, ItalyEmail danielecant@hotmail.comIntroduction: Miniscrew-assisted rapid palatal expansion (MARPE) appliances utilize the skeletal anchorage to expand the maxilla. One type of MARPE device is the Maxillary Skeletal Expander (MSE), which presents four micro-implants with bicortical engagement of the palatal vault and nasal floor. MSE positioning is traditionally planned using dental stone models and 2D headfilms. This approach presents some critical issues, such as the inability to identify the MSE position relative to skeletal structures, and the potential risk of damaging anatomical structures.Methods: A novel methodology has been developed to plan MSE position using the digital model of dental arches and cone-beam computed tomography (CBCT). A virtual model of MSE appliance with the four micro-implants was created. After virtual planning, a positioning guide is virtually designed, 3D printed, and utilized to model and weld the MSE supporting arms to the molar bands. The expansion device is then cemented in the patient oral cavity and micro-implants inserted. A clinical case of a 12.9-year-old female patient presenting a Class III malocclusion with transverse and sagittal maxillary deficiency is reported.Results: The midpalatal suture was opened with a split of 3.06 mm and 2.8 mm at the anterior and posterior nasal spine, respectively. After facemask therapy, the sagittal skeletal relationship was improved, as shown by the increase in ANB, A-Na perpendicular and Wits cephalometric parameters, and the mandibular plane rotated 1.6° clockwise.Conclusion: The proposed digital methodology represents an advancement in the planning of MSE positioning, compared to the traditional approach. By evaluating the bone morphology of the palate and midface on patient CBCT, the placement of MSE is improved regarding the biomechanics of maxillary expansion and the bone thickness at micro-implants insertion sites. In the present case report, the digital planning was associated with a positive outcome of maxillary expansion and protraction in safety conditions.Keywords: miniscrew-assisted rapid palatal expansion, MARPE, CBCT, MSE, virtual planning, cephalometrics-based digital planning, CBDP, workflow, TADCantarella DSavio GGrigolato LZanata PBerveglieri CLo Giudice AIsola GDel Fabbro MMoon WDove Medical Pressarticleminiscrew-assisted rapid palatal expansion (marpe)cone beam computed tomography (cbct)msedigital planning and workflowvirtual planningtemporary anchorage device (tad)cephalometrics-based digital planning (cbdp)Medical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol Volume 13, Pp 93-106 (2020)

A New Methodology for the Digital Planning of Micro-Implant-Supported Maxillary Skeletal Expansion

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