Comparison of bipartite versus tripartite osteotomy for maxillary transversal expansion using 3-dimensional preoperative and postexpansion computed tomography data.
OBJECTIVE
To evaluate tripartite paramedian versus bipartite median osteotomy in surgically assisted rapid maxillary expansion. Tripartite osteotomy was performed between the lateral incisors and canines at the former premaxillary junction to avoid midline diastema, septal and columellar dislocation, and asymmetric expansion, minimizing high-distraction forces through bilateral doubled osteotomy on periodontia and thus reducing vestibular attachment loss and producing stable callus formation to avoid relapse.


METHODS
The preoperative and postexpansion computed tomography data from 50 patients were analyzed in multiplanar viewing for bodily segment movement, vestibular bone loss, and transverse skeletal and dental widening with predefined landmarks. Of the 50 patients, 22 had undergone tripartite and 28 had undergone bipartite osteotomy.


RESULTS
Using an independent t test, both osteotomies permitted adequate transverse skeletal expansion in the premolars, converging, however, in the molars. Bipartite osteotomy resulted in less symmetry in transverse skeletal widening, greater bodily segment movement in the first premolar/molar, and greater vestibular bone loss. Tripartite osteotomy resulted in greater overall expansion and less bone remodeling. On variance analysis, tripartite bone-borne distraction resulted in the greatest decrease of transverse expansion in patients older than 20 years. The tripartite osteotomy also provoked distractor- and age-independent outward segmental movement. Bipartite osteotomy resulted in distractor- and age-independent inward segmental movement. Bipartite osteotomy showed the greatest bone resorption in patients younger than 20 years old in the molars and tripartite osteotomy in patients older than 20 years in the premolars.


CONCLUSIONS
Tripartite paramedian osteotomy allowed greater overall symmetric expansion compared with bipartite median osteotomy, with, however, a decline in transverse widening to the posterior. Bipartite osteotomy should be preferred whenever good periodontal status permits greater vestibular bone loss and a midline diastema and asymmetric expansion and a midline shift will be tolerated by the patient. Tripartite osteotomy should be chosen whenever a midline diastema and shift, septal and columellar dislocation, asymmetric expansion, and larger distraction forces on the paradontia, resulting in vestibular attachment loss, are to be avoided.
Landes
Constantin A
CA
Department of Oral, Maxillofacial, and Plastic Facial Surgery, Goethe University Frankfurt, Frankfurt am Main, Germany. c.landes@lycos.com
Laudemann
Katharina
K
Petruchin
Oksana
O
Mack
Martin G
MG
Kopp
Stefan
S
Ludwig
Björn
B
Sader
Robert A
RA
Seitz
Oliver
O
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000209:etiology; D001641:Bicuspid / Q000000981:diagnostic imaging; D016723:Bone Remodeling / Q000502:physiology; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000209:etiology; D003724:Dental Arch / Q000000981:diagnostic imaging / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007430:Intraoperative Care; D008310:Malocclusion / Q000601:surgery; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery*; D008875:Middle Aged; D008963:Molar / Q000000981:diagnostic imaging; D019857:Osteogenesis, Distraction / Q000379:methods*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D010155:Palatal Expansion Technique; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019227:Tooth Apex / Q000000981:diagnostic imaging; D055815:Young Adult