Assessment of Maxillary Expansion Techniques by means of 3D Elastoplastic Finite Element Static Simulation

Document Type : Research Paper

Authors
Olesya Shosheva 1
Mikhail Zhmaylo 1
Leonid Maslov 1 , 2
Aleksey Borovkov 1
Nataliia Vishneva 3
Anastasiia Lanina 4
Andrey Yaremenko 3
1 Advanced Engineering School "Digital Engineering", Peter the Great St. Petersburg Polytechnic University, 29 Politekhnicheskaya str., St. Petersburg, 195251, Russia
2 Department of Theoretical and Applied Mechanics, Ivanovo State Power Engineering University, 34 Rabfakovskaya str., Ivanovo, 153003, Russia
3 Department of Surgical Dentistry and Maxillofacial Surgery, Federal State Budgetary Educational Institution of Higher Education “Academician I.P. Pavlov First St. Petersburg State Medical University” of the Ministry of Healthcare of Russian Federation, 6–8 L’va Tolstogo str., St. Petersburg, 197022, Russia
4 Educational and Clinical Dental Center, North-Western State Medical University named after I.I. Mechnikov, 1/82 Zanevskiy av., St. Petersburg, 196006, Russia
10.22055/jacm.2024.47055.4653
Abstract
Even though numerous studies considered various approaches for maxillary expansion, there is still no consensus on which method is optimal for a patient with a particular clinical picture. The purpose of this study is to determine the optimal technique from the procedures proposed by doctors for a patient with completed facial skeleton growth. In this paper we consider four scenarios of surgical intervention, i.e., without osteotomy, midpalatal suture osteotomy, experimental osteotomy of zygomatico-alveolar ridge on the both sides of maxilla, and midpalatal suture osteotomy with osteotomy of zygomatico-alveolar ridge. In addition, two experimental appliances (one-screw expander and two-screw expander) and two positioning configurations of them (parallel to the hard palate and horizontal) are under consideration at the suggestion of the doctors. The criteria for determining the optimal technique are established in the article. Three-dimensional finite element (FE) models of skull and teeth of an adult 43-year-old patient with an ossified midpalatal suture are constructed based on the results of computed tomography, while the 3D models for the expander components are built separately and combined into the full FE system. The corresponding elastoplastic properties are adopted for the bone tissues and expander components. After proper skull fixation at the bottom, a quasi-static displacement of 0.25 mm, corresponding to quarter-turn of the control screw, is applied to the expander components to stimulate the maxillary expansion. All analyses in the paper are performed in the SIMULIA Abaqus 2021 software suite. Displacements and stresses in the bone structures of the hard palate and the appliance are obtained for all the cases studied. It was revealed that the expansion of the midpalatal suture is small in the cases without surgical intervention. A significantly greater expansion of the midpalatal suture is observed as a result of midpalatal suture osteotomy. Osteotomy of the zygomatico-alveolar ridge has virtually no effect on the value of the midpalatal suture expansion. Midpalatal suture osteotomy combined with osteotomy of the zygomatico-alveolar ridge leads to maximum expansion of the midpalatal suture. However, additional osteotomy of the zygomatico-alveolar ridge induces a proportionally greater increase in the expansion value at the dental level (by 24.8–25.8%) than at the midpalatal suture level (by 10.8–16.2%). Unlike the one-screw expander, using the two-screw expander leads to a 21.4–22.9% greater expansion of the midpalatal suture in the cases with midpalatal suture osteotomy, but increases the highly stressed regions and the magnitude of plastic strains in them. The horizontal position of the expander contributes to a more symmetrical expansion of the maxilla than positioning the expander parallel to the palate. Based on the analysis performed, we believe that midpalatal suture osteotomy might be the best scenario for surgical intervention for maxillary expansion in patients with completed facial skeleton growth. The two-screw expander is more effective in terms of maxillary expansion values, but it increases the risk of bone resorption. It is also found that providing osteotomy of zygomatico-alveolar ridge and changing the position of the expander practically does not affect the expansion state. Thus, our findings can serve as a basis for doctors deciding which scenario of surgical intervention and expander configuration would be more appropriate for a particular patient.
Keywords
Orthodontics
Maxillofacial Surgery
Osteotomy
Distraction Osteogenesis
Orthodontic Appliances
Finite Element Analysis (FEA)
Subjects

Publisher’s Note Shahid Chamran University of Ahvaz remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

[1] Baskaran, M., Arularasan, S.G., Divakar, T.K., Thirunavukkarasu R., Treatment of Micrognathia by Intraoral Distraction Osteogenesis: A Prospective Study, Annals of Maxillofacial Surgery, 7(1), 2017, 37-44.
[2] Sanz-Cortés, M., Gómez, O., Puerto, B., Micrognathia and Retrognathia, In: Copel, J.A., D'Alton, M.E., Feltovich, H., Gratacós, E., Krakow, D., Odibo, A.O., Platt, L.D., Tutschek, B., eds., Obstetric Imaging: Fetal Diagnosis and Care, Elsevier, Philadelphia, 2018.
[3] Breik, O., Tivey, D., Umapathysivam, K., Anderson, P., Mandibular distraction osteogenesis for the management of upper airway obstruction in children with micrognathia: a systematic review, International Journal of Oral and Maxillofacial Surgery, 45(6), 2016, 769-782.
[4] Morice, A., Galliani, E., Kadlub, N., Tomat, C., Vazquez, M.P., Picard, A., Diner, P.A., Dynamic orthognathic surgical procedure (DOSP) in asymmetric maxillomandibular dysmorphism secondary to unilateral microg-nathia: Outcomes of 12 consecutive cases, Journal of Cranio-Maxillofacial Surgery, 49(2), 2021, 75-83.
[5] Huang, M., Gonda, D.D., Briceño, V., Lam, S.K., Luerssen, T.G., Jea, A., Dyspnea and dysphagia from upper airway obstruction after occipitocervical fusion in the pediatric age group, Neurosurgical Focus, 38(4), 2015, E13.
[6] Koshinuma, S., Fujii, T., Okamura, T., Asada, Y., Machida, Y., Yamamoto, G., Analysis of micrognathia with obstructive sleep apnea syndrome improved by a combination of Le Fort I with horseshoe osteotomies, man-dibular distraction osteogenesis, and genioplasty, Clinical Case Reports, 10(12), 2022, e6479.
[7] Breik, O., Umapathysivam, K., Tivey, D., Anderson, P., Feeding and reflux in children after mandibular dis-traction osteogenesis for micrognathia: A systematic review, International Journal of Pediatric Otorhinolaryngology, 85, 2016, 128-135.
[8] Aronson, J., Principles of Distraction Osteogenesis, In: McCarthy, J.G., ed., Distraction of the Craniofacial Skeleton, Springer, New York, 1999.
[9] Engel, M., Berger, M., Hoffmann, J., Kühle, R., Rückschloss, T., Ristow, O., Freudlsperger, C., Kansy, K., Midface correction in patients with Crouzon syndrome is Le Fort III distraction osteogenesis with a rigid external dis-traction device the gold standard?, Journal of Cranio-Maxillofacial Surgery, 47(3), 2019, 420-430.
[10] Heggie, A.A., Kumar, R., Shand, J.M., The role of distraction osteogenesis in the management of craniofacial syndromes, Annals of Maxillofacial Surgery, 3(1), 2013, 4-10.
[11] Resnick, C.M., Padwa, B.L., Use of distraction osteogenesis in orthognathic surgery, Seminars in Orthodontics, 25(3), 2019, 205-217.
[12] Zong, C., Tang, B., Hua, F., He, H., Ngan, P., Skeletal and dentoalveolar changes in the transverse dimension using microimplant-assisted rapid palatal expansion (MARPE) appliances, Seminars in Orthodontics, 25(1), 2019, 46-59.
[13] Gogna, N., Johal, A.S., Sharma, P.K., The Stability of Surgically Assisted Rapid Maxillary Expansion (SARME): A Systematic Review, Journal of Cranio-Maxillofacial Surgery, 48(9), 2020, 845-852.
[14] Alyessary, A.S., Othman, S.A., Yap, A.U.J., Radzi, Z., Rahman, M.T., Effects of non-surgical rapid maxillary expansion on nasal structures and breathing: A systematic review, International Orthodontics, 17(1), 2019, 12-19.
[15] Kurt, G., Altuğ, A.T., Türker, G., Kiliç, B., Kiliç, E., Alkan, A. Effects of Surgical and Nonsurgical Rapid Maxillary Expansion on Palatal Structures, Journal of Craniofacial Surgery, 28(3), 2017, 775-780.
[16] Schuster, G., Borel-Scherf, I., Schopf, P.M., Frequency of and complications in the use of RPE appliances--results of a survey in the Federal State of Hesse, Germany, Journal of Orofacial Orthopedics, 66(2), 2005, 148-161.
[17] Carvalho, P.H.A., Moura, L.B., Trento, G.S., Holzinger, D., Gabrielli, M.A.C., Gabrielli, M.F.R., Pereira Filho, V.A., Surgically assisted rapid maxillary expansion: a systematic review of complications, International Journal of Oral and Maxillofacial Surgery, 49(3), 2019, 325-332.
[18] N’Guyen, T., Gorse, F.C., Vacher, C., Anatomical modifications of the mid-palatal suture during ageing. A radiographic study, Surgical and Radiologic Anatomy, 29(3), 2007, 253-259.
[19] N’Guyen, T., Ayral, X., Vacher, C., Radiographic and microscopic anatomy of the mid-palatal suture in the elderly, Surgical and Radiologic Anatomy, 30(1), 2008, 65-68.
[20] Kapetanović, A., Theodorou, C.I., Bergé, S.J., Schols, J.G.J.H., Xi, T., Efficacy of Miniscrew-Assisted Rapid Palatal Expansion (MARPE) in late adolescents and adults: a systematic review and meta-analysis, European Journal of Orthodontics, 43(3), 2021, 313-323.
[21] Choi, S.H., Jeon, J.Y., Lee, K.J., Hwang, C.J., Clinical applications of miniscrews that broaden the scope of nonsurgical orthodontic treatment, Orthodontics & Craniofacial Research, 24(S1), 2021, 48-58.
[22] Haas Junior, O.L., Matje, P.R.B., da Rosa, B.M., Rojo-Sanchis, C., Guijarro-Martínez, R., Valls-Ontañón, A., de Menezes, L.M., Hernández-Alfaro, F., de Oliveira, R.B., Minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) in adult patients, Journal of Cranio-Maxillofacial Surgery, 50(3), 2022, 211-217.
[23] Bastos, R.M., Haas Junior, O.L., Piccoli, V., da Rosa B.M., de Oliveira, R.B., de Menezes, L.M., Effects of minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) on the nasal cavity and upper airway: a comparative cohort study, International Journal of Oral and Maxillofacial Surgery, 53(10), 2024, 821-828.
[24] Júnior, S.M.L., Moraes, M., Asprino, L., Photoelastic Analysis of Stress Distribution of Surgically Assisted Rapid Maxillary Expansion With and Without Separation of the Pterygomaxillary Suture, Journal of Oral and Maxillofacial Surgery, 69(6), 2011, 1771-1775.
[25] Vardimon, A.D., Brosh, T., Spiegler, A., Lieberman, M., Pitaru, S., Rapid palatal expansion. Part 2: Dentoskeletal changes in cats with patent versus synostosed midpalatal suture, American Journal of Orthodontics and Dentofacial Orthopedics, 113(5), 1998, 488-497.
[26] Elias, C.N., Fernandes, D.J., Zanivan, D.S., Fonseca, Y.R., Extensiometric analysis of strain in craniofacial bones during implant-supported palatal expansion, Journal of the Mechanical Behavior of Biomedical Materials, 76, 2017, 104-109.
[27] Maslov, L., Borovkov, A., Maslova, I., Soloviev, D., Zhmaylo, M., Tarasenko, F., Finite Element Analysis of Customized Acetabular Implant and Bone after Pelvic Tumour Resection throughout the Gait Cycle, Materials, 14(22), 2021, 7066.
[28] Donnik, A.M., Kossovich, L.Yu., Olenko, E.S., Biomechanics of the spine in fracture of the spine before and after surgical treatment. Biomechanical experiment, Russian Journal of Biomechanics, 26(1), 2022, 25-39.
[29] Maslov, L., Zhmaylo, M., Maslova, I., Purkova, S., Tarasenko, F., Sushentov, E., Barriere, T., Some aspects of custom-made 3d-printed hip joint implant structural simulation, IOP Conference Series: Materials Science and Engineering, 986(1), 2020, 012035.
[30] Barabash, Yu.A., Ivanov, D.V., Bogatov, V.B., Lychagin, A.V., Biomechanical approach to the choice of the type of intramedullary fixator in a simulated femoral fracture, Russian Journal of Biomechanics, 25(2), 2021, 209-217.
[31] Maslov, L., Surkova, P., Maslova, I., Solovev, D., Zhmaylo, M., Kovalenko, A., Bilyk, S., Finite-element study of the customized implant for revision hip replacement, Vibroengineering PROCEDIA, 26(1), 2019, 40-45.
[32] Bauman, Z.M., Herrmann, S., Kött, T., Binkley, J., Evans, C.H., Kamien, A., Cemaj, S., Berning, B., Cantrell, E., Finite element analysis for better evaluation of rib fractures: A pilot study, Journal of Trauma and Acute Care Surgery, 93(6), 2022, 767-773.
[33] Xue, H., Zhang, Z., Liu, M., Lin, Z., Endo, Y., Liu, G., Mi, B., Zhou, W., Liu, G., Finite element analysis of different fixation methods of screws on absorbable plate for rib fractures, Frontiers in Bioengineering and Biotechnology, 10, 2022, 960310.
[34] Meng, L., Zhang, Y., Lu, Y., Three-dimensional finite element analysis of mini-external fixation and Kirschner wire internal fixation in Bennett fracture treatment, Orthopaedics & Traumatology: Surgery & Research, 99(1), 2013, 21-29.
[35] Wong, D.W., Niu, W., Wang, Y., Zhang, M., Finite Element Analysis of Foot and Ankle Impact Injury: Risk Evaluation of Calcaneus and Talus Fracture, PLoS One, 11(4), 2016, e0154435.
[36] Djebbar, N., Bachiri, A., Boutabout, B., A three-dimensional finite element analysis of the influence of a strike load from a variable mass impactor on the stress distribution to the bone-implant interface, Russian Journal of Biomechanics, 27(1), 2023, 10-21.
[37] Hartono, N., Soegiharto, B.M., Widayati, R., The difference of stress distribution of maxillary expansion using rapid maxillary expander (RME) and maxillary skeletal expander (MSE) – a finite element analysis, Progress in Orthodontics, 19(1), 2018, 33.
[38] Trezubov, V.N., Mishnev, M.L., Parshin, Yu.V., Modestov, V.S., Yarekha, D.I., Experimental study of the dis-tribution of elasticity in the peri-implant bone during prosthetics, Russian Journal of Biomechanics, 27(3), 2023, 10-23.
[39] Kumar, A., Ghafoor, H., Khanam, A., A comparison of three-dimensional stress distribution and displacement of nasomaxillary complex on application of forces using quad-helix and nickel titanium palatal expander 2 (NPE2): a FEM study, Progress in Orthodontics, 17(1), 2016, 17.
[40] Rozov, R.A., Higuchi, K.W., Brunski, J., Trezubov, V.N., Smerdov, A.A., Mishnev, M.L., 3D finite element analysis of the dental implant loss effect on the stress distribution in the mandibular implant-supported prosthesis, Russian Journal of Biomechanics, 27(3), 2023, 18-26.
[41] Möhlhenrich, S.C., Modabber, A., Kniha, K., Peters, F., Steiner, T., Hölzle, F., Fritz, U., Raith, S., Simulation of three surgical techniques combined with two different bone-borne forces for surgically assisted rapid palatal expansion of the maxillofacial complex: a finite element analysis, International Journal of Oral and Maxillofacial Surgery, 46(10), 2017, 1306-1314.
[42] Kaya, N., Seker, E.D., Yücesoy, T., Comparison of the effects of different rapid maxillary expansion techniques on craniofacial structures: a finite element analysis study, Progress in Orthodontics, 24(1), 2023, 7.
[43] de Assis, D.S., Xavier, T.A., Noritomi, P.Y., Gonçales, A.G., Ferreira, O.C.Jr., de Carvalho, P.C., Gonçales, E.S., Finite element analysis of stress distribution in anchor teeth in surgically assisted rapid palatal expansion, International Journal of Oral and Maxillofacial Surgery, 42(9), 2013, 1093-1099.
[44] Dalband, M., Kashani. J., Hashemzehi, H., Three-Dimensional Finite Element Analysis of Stress Distribution and Displacement of the Maxilla Following Surgically Assisted Rapid Maxillary Expansion with Tooth- and Bone-Borne Devices, Journal of Dentistry (Tehran), 12(4), 2015, 298-306.
[45] Zawiślak, E., Olejnik, A., Frątczak, R., Nowak, R., Impact of Osteotomy in Surgically Assisted Rapid Maxillary Expansion Using Tooth-Borne Appliance on the Formation of Stresses and Displacement Patterns in the Facial Skeleton—A Study Using Finite Element Analysis (FEA), Applied Sciences, 10(22), 2020, 8261.
[46] MacGinnis, M., Chu, H., Youssef, G., Wu, K.W., Machado, A.W., Moon, W., The effects of micro-implant assisted rapid palatal expansion (MARPE) on the nasomaxillary complex—a finite element method (FEM) analysis, Progress in Orthodontics, 15(1), 2014, 52.
[47] Priyadarshini, J., Mahesh, C.M., Chandrashekar, B.S., Sundara, A., Arun, A.V., Reddy, V.P., Stress and dis-placement patterns in the craniofacial skeleton with rapid maxillary expansion—a finite element method study, Progress in Orthodontics, 18(1), 2017, 17.
[48] Liu, P.-H., Chen, Y.-F., Pan, C.-Y., Sheen, M.-H., Chen, B.-S., Chang, H.-P., Maxillary Skeletal Expansion with Monocortical and Bicortical Miniscrew Anchorage: A 3D Finite Element Study, Applied Sciences, 12(9), 2022, 4621.
[49] Yoon, S., Lee, D.-Y., Jung, S.-K., Influence of changing various parameters in miniscrew-assisted rapid palatal expansion: A three-dimensional finite element analysis, Korean Journal of Orthodontics, 49(3), 2019, 150-160.
[50] Sarna-Boś, K., Skic, K., Boguta, P., Adamczuk, A., Vodanovic, M., Chałas, R., Elemental mapping of human teeth enamel, dentine and cementum in view of their microstructure, Micron, 172, 2023, 103485.
[51] SCHEU-DENTAL Catalogue. Available online: https://www.scheu-dental.com/fileadmin/download/Kataloge/Katalog_2021_0100_EN.pdf (accessed on 15 January 2024).
[52] VECTOR® Instructions for Use. Available online: https://www.scheu-dental.com/fileadmin/product_resources/Vector_600+800_BPZ_0142_GB_Original_3374.pdf (accessed on 15 January 2024).
[53] Nishimoto, T., Murakami, S., Abe, T., Ono, K., Mechanical Properties of Human Cranium and Effect of Cranial Fractures on Extradural Hematoma, Transactions of the Japan Society of Mechanical Engineers Series A, 61, 1995, 2386-2392.
[54] Dejak, B., Młotkowski, A., 3D-Finite element analysis of molars restored with endocrowns and posts during masticatory simulation, Dental Materials, 29(12), 2013, e309-e317.
[55] Rubin, C., Krishnamurthy, N., Capilouto, E., Yi, H., Stress analysis of the human tooth using a three-dimensional finite element model, Journal of Dental Research, 62(2), 1983, 82-86.
[56] Faot, F., Panza, L.H., Garcia, R.C., Cury, A.A., Impact and Flexural Strength, and Fracture Morphology of Acrylic Resins with Impact Modifiers, Open Dentistry Journal, 3, 2009, 137-143.
[57] EN 1.4301 (X5CrNi18-10) Stainless Steel. Available online: https://www.makeitfrom.com/material-properties/EN-1.4301-X5CrNi18-10-Stainless-Steel (accessed on 15 January 2024).
[58] Karagkiolidou, A., Ludwig, B., Pazera, P., Gkantidis, N., Pandis, N., Katsaros, C., Survival of palatal miniscrews used for orthodontic appliance anchorage: A retrospective cohort study, American Journal of Orthodontics and Dentofacial Orthopedics, 143(6), 2013, 767-772.
[59] Ludwig, B., Glasl, B., Bowman, S., Wilmes, B., Kinzinger, G., Lisson, J., Anatomical guidelines for miniscrew insertion: Palatal sites, Journal of Clinical Orthodontics, 45(8), 2011, 433-441.
[60] Capelozza, F.L., Cardoso, N.J., Silva, O.G., Ursi, W.J., Non-surgically assisted rapid maxillary expansion in adults, International Journal of Adult Orthodontics and Orthognathic Surgery, 11(1), 1996, 57-66.
[61] Anttila, A., Finne, K., Keski-Nisula, K., Somppi, M., Panula, K., Peltomäki, T., Feasibility and long-term stability of surgically assisted rapid maxillary expansion with lateral osteotomy, European Journal of Orthodontics, 26(4), 2004, 391-395.
Journal of Applied and Computational Mechanics
Volume 11, Issue 3
Summer 2025
Pages 715-737