The Transverse Sagittal Maxilary Expander

The transverse sagittal maxilary expander
Giampietro farronato,MD,DDS,MSD
Giancarlo cordasco,MD,DDS
Luca Esposito, MD, DDS, MSD
Enrico briguglio,DDS
The treatment plan a patient with maxillaryhipoplasia depends on the clinical manifestation of the malocclusion in the sagital, transverse, and vertical planes. Studies have confirmed that anreroposterior traction of the sutural fibers tostimulate osteogenesis and correct the sagittal position of the upper jaw treatment of choice for class III patients age 5 to 15. When combined with a facemask, a palatal expander acts predominantly in thetransverse plane, placing traction on the median palatal suture and thus on the surrounding maxillary sutures. If applied before the pubertal growth peak,this anteroposterior traction can advance theentire upper dentoalveolar process. We have sometimes found it necessary to expand the maxilla in the sagittal plane as well, especially in a case with maxillary crowding,adding bilateral sagittalscrews to the palatal expander produces a relatively slow increase In the sagittal dimension
The transverse sagittal maxillary expander (TSME) is our modification of the rapid palatal expander it isindicated in patients with mild skeletal class III malocclusion and maxillary crowding or with maxillary hypoplasia and reduced transverse and sagittal dimensions. In growing children with averagedivergence of the osseomaxillary bases, the TSME can be used in combination with a Delaire facemask. The resulting increase in maxillary perimeter length is especially useful in cases of crowding anddental inclusions to the left and right first molars an 11mm Hyraxtype transverse expansion screw, two .045 stainless steel wires extendine ti the palatal surfaces of the central incisors, and two 8mmHyrax-type screws attached to these wires between the molar bands and the incisors.
In the first phase of treatment, the palate is rapidly expanded by activating the transverse screw one-quarter...