Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2016-04-19, 11:44:05 | version 1.38.0
| industry report palatal expansion screw 34 ortho 1 2016 The patient was examined after one week. The parents reported that they had noted the creation of an inter-incisive diastema on the 5th day, as is generally the case at this age, from our experience. Wedischargedthepatientafterhavingpersonally activated the screw to check its stability and the ef- ficacy of the stopping device. On the 14th day, we terminated activation as the pre-determined amount of expansion of 5.5 mm had been reached (Figs. 5a & b). The correct amount of activation was confirmed by the reference notches. As you can see from the photo, the third notchisabouttoappear,indicating6mm,butisstill slightly hidden by the sliding guide, while the two previous notches are clearly visible on the body of the Expander. The Expander remained blocked in the mouth for 1 month and was then replaced with a Quad helix (Fig. 6), which includes a marker for lingual reposi- tioning. TheQuadhelixremainedinthemouthforanother 4months,afterwhichnoothertypeofrestraintwas required.Thisprotocolprovidesforthereplacement of the rapid expander with a Quad helix 1 month after the end of activation. It is a protocol we have been using for more than 20 years and has been tested on more than a hundred cases, proving to be particularly effective and free of any contraindica- tions. In fact in our opinion, 1 month is more than enough for the consolidation of the midpalatal su- ture, given that this is the average time required for the consolidation of fractures. ThereplacementoftheExpanderwithaQuadhe- lixprovidedwithalingualmarkeroffersthefollow- ing advantages: it reduces the encumbrance to the palate. In fact, often owing to its encumbrance, the rapidExpanderforcesthetongueintoalow,forward position, with a subsequent open bite from lingual dysfunction. As well as maintaining the breadth obtained with the rapid expander, the Quad helix can also increase it, by activating it by the required amount. Thanks to the lingual marker, together with the modest encumbrance to the palate offered by the Quad helix (note its modelling in the photo), myo- functional re-education can be initiated immedi- ately. This is definitely more important, in terms of thestabilityoftheexpansionandtheprolongeduse of the expander as a maintenance guard, given that the same prevents correct lingual repositioning, an indispensable condition for the stability of our treatment in the long term. In addition, since it is an elastic device, the Quad helix does not block the two hemimaxillae together, thus allowing the jaw to adapt to the occlusal forces, certainly a useful condition for the cranial architecture, which is also welcomed for osteo- pathic treatment. Conclusions In both bench and clinical testing, the Expander has proven to be extremely precise, assembled with care, solid and without any flexion. The parents of the patient activated the screw at home with particular ease and precision, thanks to thebrakingdevice.Infactthisfeatureenabledthem to hear a ‘click’ upon each activation, and above all to not turn the screw back when removing the key, thus undoing the activation they had just com- pleted.Thisissuchafrequentoccurrenceduringthe activation of traditional Expanders. The whole pro- cesswentaheadwithoutanyproblemsandwiththe maximumlevelofcomfortfortheyounggirl,thanks alsotothecompactsizeoftheExpander,permitting effective and safe use in very young patients. The arm and the screw of the Expander were proven to be precise and without any flexion. The reference notches printed on the screw enabled the clinician to check that the activation had been per- formed correctly. All this resulted in a greater sense ofsecurityforboththepatientandthetherapist,as well as being appreciated as an indicator of a high level of professionalism._ Editorialnote:Acompletelistofreferencesisavailablefrom thepublisher. contact Dr Gabriele Galassini is a surgeon and orthodontist. Dr Galassini has been a contract Professor at Scuola di Specialità in Ortognatodonzia,Univesity of Trieste since 2005.He is also a lecturer at Osteopathic College inTrieste. Via Crociera 10 34074 Monfalcone (Go) Italy segreteria@studiogalassini.it www.studiogalassini.it Dr Elena Marcuzzi Surgeon,Orthodontist Specialist Dr Paulina Natasa Orthodontist Fig.6: The Expander remained blocked in the mouth for 1 month and was then replaced with a Quad helix. Fig.6 12016