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Orthopedic forces to expand and protract the maxillary complex were commonly applied to the upper dental arch. This approach incurred well-known side effects such as proclination of the upper front teeth, bite opening, mesial movement of the lateral segments, and buccal tipping of the anchorage teeth. New skeletal anchorage concepts involving surgical mini-plates or mini-implants have been developed to address these problems. Directing orthopedic forces directly into the bony structures of the midface promised a significant reduction of dental side effects as well as an enhancement of skeletal response. To further increase orthopedic treatment effects, some maxillary protraction protocols include rapid maxillary expansion (RME) in order to stimulate the midface sutures. RME can be carried out purely bone-borne or with a combination of dental and skeletal anchorage using mini-implants in the anterior palate (Hybrid-Hyrax). Recently, new digital technique were incorporated in this approach using CAD/CAM insertion guides and 3D printing of metal appliances.
Learning Objectives:
Identify the advantages of skeletal anchorage for RME & class III treatment.
Design mini-implant borne expanders depending on the bone availability.
Use new digital techniques to widen orthopedic treatment possibilities.
