Authors: Dr. Julia Steinmaier (née Funke), Dr. Werner Schupp
Introduction: The development of palatal expansion (GNE)
Die Gaumennahterweiterung (GNE) wurde erstmals 1860 beschrieben und hat sich als etablierte Methode zur Behandlung eines transversal unterentwickelten Oberkiefers bei Kindern und Jugendlichen durchgesetzt. Ziel der GNE ist es, die noch nicht vollständig verknöcherte Sutura palatina mediana zu erweitern, um Platz im Oberkiefer zu schaffen und Kreuzbisse zu korrigieren. Klassischerweise erfolgt die Verankerung durch festsitzende Apparaturen oder skelettale Mini-Implantate (TADs).
Indications for GNE
- Bi- and unilateral posterior crossbites
- Preparation of Class II/III patients with narrow upper jaw
- Bottleneck with space deficit of at least 4 mm
- Improvement of nasal breathing by widening the nasal cavity
The problem of fixed appliances
Fixed GNE appliances have some disadvantages:
- Restricted oral hygiene
- Risk of Gum inflammation and demineralization
- Need for long-term retention
The attachment-anchored, removable GNE appliance
This alternative method combines the advantages of aligner therapy with the principles of palatal expansion:
- Removable appliance with individual fit
- Anchoring with attachmentswhich are bonded to the teeth
- Production by means of laminating technology (LAMItec) for more stability
Production and application
1. Direct bonding of attachments on molars and premolars for better splint retention
2. Thermoforming process for manufacturing the appliance from polycarbonate layers with integrated expansion screws
3. Use and activation by daily screw activation (0.25 mm)
4. Wearing recommendation: Wear all the time except when eating and brushing teeth
Patient cases: Clinical outcomes
Three children (8-9 years) with a transversely constricted maxilla were treated with the removable GNE appliance.
- Intercanine distance increased on average by 4.7 mm increased
- Intermolar distance grew by 4.8 mm
- Tooth arch length increased by 3.1 mm
- The crossbites were successfully transferred
Discussion and conclusion
The attachment-anchored GNE appliance offers a minimally invasive alternative to fixed systems. It enables better oral hygienereduces the risk of inflammation of the gums and is better accepted by patients. The results show an effective expansion of the upper jaw, whereby careful patient education is essential. Retention is necessary to stabilize the treatment result, often in combination with functional orthodontic appliances such as a bionator or activator.
Source:
Funke, J., & Schupp, W. (2019). The attachment-anchored appliance for palatal expansion: a minimally invasive alternative. Orthodontics, 33(4), 395-403.